Registered Nurse Case Manager​/Bilingual Spanish; Req

Job Title: Registered Nurse Case Manager/ Bilingual Spanish(Req)

Duration: Contract 6+ Months

Shift: Mon - Fri | 8:00 a.m. to 5:00 p.m.

Work Arrangement: Fully Onsite

Location: Orange, CA 92868

Pay Rate Range: $43.66 - $69.86 per hr. on W2

85% - Care Management:

• Assesses member needs using a standardized health needs assessment or health risk assessment.
• Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of:
• Member's physical, functional, social and psychological status
• Member's cultural and linguistic needs
• Caregiver resources and available benefits
• Performs post-discharge assessments to identify member's post-hospital or post-emergency department discharge needs including but not limited to:
• Member's physical, functional, social and psychological status
• Member's cultural and linguistic needs
• Caregiver resources and available benefits
• Follow-up provider care and ensuring scheduled appointments
• Durable medical equipment and supplies
• Community resources
• Develops and implements a member's specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals.
• Reviews, modifies and updates care plans continuously to reflect the member's needs, at minimum, annually or upon change in condition.
• Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goals.
• Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards.
• Coordinates care and services with members, members' family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS).
• Communicates with member's physicians, specialists, community agencies and vendors to ensure coordination of services.
• Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources.
• Facilitates and participates in Interdisciplinary Team meetings as applicable.
• Collaborates with interdepartmental staff in case resolution as needed.
• Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner.
• Advocates in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals.

10% - Administrative Support:

• Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Follows Cal Optima Health's protocol for documenting all case interventions.
• Prepares and maintains appropriate documentation of patient care and progress within the care plan.

5% - Other:

• Completes other projects and duties as assigned.

• Associate degree in nursing (ADN) or related field required PLUS 3 years of clinical experience and/or managed care experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• Bilingual in English and Spanish, one of Cal Optima Health's defined threshold languages required.

• Bachelor of Science in Nursing (BSN) degree or related field.
• Case Management Certification (CCM).

• Current, unrestricted Registered Nurse (RN) license to practice in the state of California required.

• Develop rapport and establish and maintain effective working relationships with Client's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.