Care Manager (Transitional Care Services)
CalOptima Health is seeking a highly motivated an experienced Care Manager to join our team. Transitional Care Services (TCS) is a collaborative practice responsible for supporting CalOptima Health’s members to ensure successful transitions of care and connection to needed services and supports. The Care Manager for TCS will facilitate communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and cost-effective outcomes for members who have recently discharged from the hospital, emergency department (ED) or are experiencing a transition of care, including any member that is identified, referred or recommended by the discharging facility. The incumbent will be responsible for ensuring appropriate transitions of care in collaboration with the member, designated family members, post-discharge providers, CalOptima Health’s providers, health networks and community partners. The incumbent will serve as a resource for CalOptima Health’s providers, health networks and community partners.
Position Information :
- Department : Utilization Management
- Salary Grade : 310 - $72,096 - $115,353 ($34.66 - $55.4582)
- Work Arrangement : Full Telework
- This position is eligible for telework in California.
Duties & Responsibilities :
85% - Transitional Care ServicesAssesses member needs using a standardized health needs assessment or health risk assessment with member or member’s representative.Performs post-discharge assessment to identify member’s post-hospital, post-ED or post-transition of care needs including but not limited to :Member’s physical, functional, social and psychological statusMember’s cultural and linguistic needsCaregiver resources and available benefitsFollow-up provider care and ensuring scheduled appointmentsDurable medical equipment and suppliesCommunity resourcesDevelops and implements a member’s specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals; care plan will be continuously reviewed, modified and updated to reflect the member’s needs.Schedules weekly follow-ups with member or member’s representative to assess progress towards goals and identifies barriers to meeting goals.Provides regular outreach to assigned members along with assigned members from a worklist and evaluates quality of service given to members according to department contact standards.Coordinates care, services and referrals with members, members’ family members / representatives and other providers, as appropriate, including community supports and Long-Term Support Services (LTSS).Conducts face-to-face meetings at settings outside of CalOptima Health’s locations such as in hospitals, skilled nursing facilities, long-term acute care hospitals, recuperative care and in member’s home settings with members, members’ family members / representatives and other providers, as appropriate.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 the LTSS department, community supports and community resources.Facilitates and participates in Interdisciplinary Care Team meetings, as applicable.Collaborates with interdepartmental staff in case resolution as needed.Identifies cases needing manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner.Prepares and maintains appropriate documentation of patient care and progress within the documentation platform or care plan as appropriate.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 CalOptima Health’s protocol for documenting all case interventions.Ensures reporting of productivity metrics to supervisor.5% - Completes other projects and duties as assigned.
Minimum Qualifications :
Bachelor’s degree in social work, psychology, gerontology, public health or related field PLUS 2 years of clinical experience and / or managed care experience required.Valid driver’s license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 20% of the time or more.Preferred Qualifications :
Licensed Vocational Nurse, Registered Nurse or master’s degree in social work, gerontology, public health or related field.Experience with behavioral health or substance use case management.Certified Case Manager (CCM) certificate.Bilingual in English and one of CalOptima Health’s defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).Required Licensure / Certifications :
n / aKnowledge & Abilities :
Develop rapport and establish and maintain effective working relationships with CalOptima Health'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.Physical Requirements (With or Without Accommodations) :
Ability to visually read information from computer screens, forms and other printed materials and information.Ability to speak (enunciate) clearly in conversation and general communication.Hearing ability for verbal communication / conversation / responses via telephone, telephone systems, and face-to-face interactions.Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.Lifting and moving objects, patients and / or equipment 10 to 25 poundsTo apply and for the full job description please visit : https : / / apptrkr.com / 5879447
Compensation Information :
72096.00 / Annually - $115353.00 / Annually
Salary : $72,096 - $310,000
