Care Manager

Care Manager

Requirements

• Associate degree in nursing
• Minimum two (2) years of experience in medical management clinical functions
• Working knowledge of MCG, InterQual, and NCQA standards
• Active License as a Registered Nurse (RN) in California

Responsibilities

• Assessment of the medical, social, and behavioral needs of an assigned population
• Care Plan development and prioritization to transition members to optimal levels of health and self-management
• Capacity to coordinate interdisciplinary team meetings as required
• Collaboration across providers and healthcare settings to ensure optimal quality outcomes for an assigned population
• Provide transition of care interventions as required
• Facilitate care coordination, self-management planning, discharge planning, and health education for an assigned population
• Facilitate linkage to appropriate community resources to address social determinants of health
• Capacity to adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across all care settings
• Able to ensure member communication and notices are composed in a manner consistent with regulatory standards
• Adheres to the Policies and Procedures set forth by the Quality Management Committee
• Other duties and responsibilities as assigned

Preferred Qualifications

• Bachelor’s degree preferred
• Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred