What are the responsibilities and job description for the Medical Case Manager (RN) Long Term Care position at Sunshine Enterprise USA LLC?
Medical Case Manager RN Long Term Care
Company Overview : Our client is a leading healthcare located in Orange, CA, seeking a medical case manager for the long-term care department, where they provide ongoing case management services members, facilitate communication and coordination among all participants of the health care team for cost-effective outcomes for all members through providing intensive case management.
Position Summary : The successful candidate should hold a current, unrestricted registered nurse (RN) license to practice in the state of California, holds a bachelor’s degree in nursing, and has 3 years of clinical experience with long term care / community health experience.
Work Duration : Up to 6 months
Work hours : 8 am – 5 pm, M-F
Position Responsibilities :
- Assesses member needs using a standardized health needs assessment or health risk assessment
- Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of : Member’s physical, functional, social and psychological status Member’s cultural and linguistic needs Caregiver resources and available benefits Member’s physical, functional, social and psychological status, cultural and linguistic needs and caregiver resources and available benefits
- Performs post-discharge assessments to identify member’s post-hospital or post-emergency department discharge needs
- Develops and implements a member’s specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals.
- Reviews, modifies and updates care plans continuously to reflect the member’s needs, at minimum, annually or upon change in condition.
- Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goal. Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards.
- Coordinates care and services with members, members’ family members / representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS).
- 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 LTSS department, community supports and community resources.
- Facilitates and participates in Interdisciplinary Team meetings as applicable.
- Collaborates with interdepartmental staff in case resolution as needed
- Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner.
- Advocates in the member’s best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals.
- Complete additional assignments and projects as assigned.
Experience & Education :
Necessary Attributes :
Sunshine Enterprise USA is an “Equal Opportunity Employer—Minorities, Females, Veterans and Disabled Persons”
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