What are the responsibilities and job description for the Case Manager position at Hill Physicians Medical Group?

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At Hill Physicians Medical Group, we're shaping the healthcare of the future : actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

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At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description :

Responsible for carrying out case management activities for IPA members referred to the case management program across all levels of care. Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services required to meet the client's health and human service needs. It is characterized by advocacy, communication and resource management and promotes quality and cost-effective interventions and outcomes. Case management activities are based on nationally recognized case management standards and concepts and principles. All contacts are telephonic with an option for on-site case conferences as needed.

Job Responsibilities

Identification of members appropriate for case management, based on identification of health-related problems.
Assessing members' physical and psychosocial needs / barriers.
Developing the case management care plan.
Developing and implementing the interventions needed to resolve barriers and coordinate care, allowing members to accomplish their goals with physician guidance and supervision.
Documenting assessments, care plans, interventions, and all other activity related to coordinating the care of case-managed members.

Additional Responsibilities

Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.

Maintain department procedure / policy standards with regard to turnaround time, etc.

Support the interdisciplinary team approach to ensure effective resource utilization, as well as quality and cost-effective outcomes.

Coordinate internal and external resources for the individual member.

Maintain and update a community resource database.

Document all case management activities in the HPMG case management online system.

Utilize existing reports and systems to identify and monitor utilization resource patterns and facilitate needed care coordination in order to support Quality Improvement.

Refer to various departments for supportive interventions, i.e., Health Education, Quality Management, Contracting, Provider Services, Client Data Management, TPL, COB, etc.

Issue letters of explanation in accordance with department policy.

Support Medical Management Team, Authorization Review, Clinical Initiatives, and Provider Education.

Attend and participate in in service programs and conferences that support practice of case management.

Perform other duties as assigned.

Required Experience

Minimum 3 - 5 years of experience required

Minimum three years clinical nursing experience in an area such as medical surgical, critical care, home health or skilled nursing, and;

Two years of experience in case management, utilization management, discharge planning and or quality improvement in a managed care setting

Experience with managed care delivery including IPA networks and Medicare.

Optimum organizational skills with ability to meet both expected and unexpected time frames.

Excellent verbal and written communication skills.

Ability to coordinate effectively with a variety of customers including members, providers, office staff, health plans, internal department, community resources, and peers.

Ability to work independently with self-initiative and discipline.

Knowledge of ICD-10 and or CPT coding.

Working knowledge of personal computers.

Required Education

A.S. degree

Unrestricted California Registered Nurse licensure; certification in case management preferred.

Additional Information

Salary

85,000 - $118,000 Annually

Hill Physicians is an Equal Opportunity Employer

Salary : $85,000 - $118,000

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