HC - Case/Care Manager - Senior

LVN or RN Case Manager?

The SNP / CMC Care Manager is responsible for managing low and moderate riskSpecial Needs Population (SNP) and Dual Eligible (DE) members. SNP / CMC CareManager will ensure that the SNP and DE receive an assessment. Ensures theindividualized care plan is developed and presented timely to the IDCT.?


? Managers a case load of 400-600 low to moderate riskSNP and or CMC members.?
? Coordinates and schedules all IDCT meetings?
? Ensures all SNP and DE members are presented at IDCTat least annually?
? .Facilitates Primary Care Provider attendance?
? Ensures SNP and DE member and or caregiverparticipation?
? Obtains the health plan HRA from various websites?
? Oversees the low risk SNP and DE population and ensures the annualreview of the care plan is completed for those members who did not have achange in health status.?
? Manages all communication and information flow?
? Completes the model of care training annually?
? Works collaboratively with the patient, physician, family/significantother and providers of healthcare to implement plan of care to meet theindividual needs.?
? Works collaboratively with discharge planners at the affiliatedhospitals and case management staff to identify changes in health status.?
? Coordinates referrals to LTSS as indicated.?
? Provides patients with education and training regarding specific healthcare needs.?
? Monitors care, which is easily accessible with no access barriers asrelated to the patient?s available benefits.?
? Facilitates early and intensive treatment intervention in the leastrestrictive setting.?
? Facilitates the scheduling of follow up services as appropriate.?
? Provides accurate and up-to-date information to practitioners regardingclinical practice guideline criteria and patient information.?
? Creates individualized treatment plans that incorporate the HRA,community LTSS services?
? Utilizes multidisciplinary clinical, rehabilitative and supportservices.?
? Grants adequate attention to patient satisfaction through the evaluationand improvement of the care coordination process.?
? Upholds strict rules of confidentiality.?
? Provides ongoing Care coordination program analysisand development.?
? Encourages collaborative collegial approaches to theCase Management process.?
? Promote the Care coordination Program?s viability andaccountability.?
? Other duties as assigned?

Professional Certification or License?

? Active RN or LVN license inthe State of California?
? Valid California Driver?s license and insurance?
Level of Experience?
? A minimum of 2 yearsexperience in managed care environment, preferably in an IPA or MSO. Other casemanagement experience will be considered.?
Specific Knowledge, Skills, and Abilities?

? Knowledge of HMO UM and QMProcesses.?
? Knowledge of and experience with the utilization of UM criteria such asMilliman & Robertson, Medicare and Medicaid guidelines, health plancriteria, etc.?
? General knowledge of IPA Operations?
? Familiar with various financial risk arrangements?
? Computer literate in Microsoft Word and Excel.?
? Strong verbal and written communication skills.?
? Knowledge of and experiencewith medical coding.?
? Strong ability to work effectively with physicians and other clinical andoperational staff, both written and verbally.?
? Self motivated with strong organizational skills.?
? Ability to look at challenges as opportunities.?
? Flexible and adaptable of schedule to attend various meetings and/or promotionalevents.?
? Ability to read quickly with excellent comprehension and retention.?
What software skills are needed? They need to know Outlook, MS Office?
What are the hours? ( Traininghours?) Hours are 8-5 with a 1 hour lunch or 8:30 ? 5 with ? hour lunch.
At Maxim Healthcare Services, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:
  • Competitive pay & weekly paychecks
  • Health, dental, vision, and life insurance
  • 401(k) savings plan
  • Awards and recognition programs?
Benefit eligibility is dependent on employment status.?

Maxim Healthcare Services is a leading provider of home healthcare, medical-related staffing, travel nursing, and population health and wellness services across the United States. As an established community partner, we have been making a difference in the lives of our employees, caregivers, and patients for more than 30 years. Our commitment to customer service, improving patient care, and staffing experienced healthcare professionals has paved the way for many rewarding career opportunities in the healthcare industry. ?

Maxim Healthcare Services, Inc. is an Affirmative Action/Equal Opportunity Employer


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