Care Manager II (CA)

Company: Health Net of California
Location: Woodland Hills
Posted on: January 15, 2021

Job Description:

Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.* Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options* Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes* Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients* Provide patient and provider education* Facilitate member access to community based services* Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan* Actively participate in integrated team care management rounds* Identify related risk management quality concerns and report these scenarios to the appropriate resources.* Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience* Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems* Direct care to participating network providers* Perform duties independently, demonstrating advanced understanding of complex care management principles.* Participate in case management committees and work on special projects related to case management as neededQualifications - InternalEducation/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.Licenses/Certifications: Current state's RN license

Keywords: Health Net of California, Los Angeles , Care Manager II (CA), Executive , Woodland Hills, California