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Clinicas del Camino Real, Inc. · 1 day ago

General Case Manager

Camarillo, CA

Full-time

Onsite

Entry, Mid Level

$81K/yr - $96K/yr

1+ years exp

Clinicas del Camino Real, Inc. is seeking a General Case Manager to support their membership through care management duties. The role involves assessing, planning, and coordinating medical and social services for members identified as medium rising risk or high utilizers, with a focus on improving health outcomes through effective communication and community engagement.

DentalHealth CareMedicalMental Health

Hiring Manager

Leslie Ramos

Responsibilities

Assess, plan and coordinate aspects of medical and supporting services across the continuum of care for member identified to be medium rising risk or high utilizers

Work with the care management and coordination teams to identify care medical and social needs and to establish support services to promote quality member outcomes

Develop, guide and provide case management services by utilizing clinical expertise, and coordination efforts with the medical management team, community supports and contracted upstream health plan

Analyze medical trends and intervene with members identified to be at rising medium risk and/or high utilizers

Interact with members’ primary care physicians, and specialists to provide seamless case management activities across the care continuum

Interact with community/system resources, and maintain resource directories of collaborative and supporting agencies

Establish individualized member care plans that incorporate prioritized case goals, implementation plans, and ongoing measurement of outcomes

Access and utilize data from various data systems to create a comprehensive member case file that is supported with member assessments, clinical reports, encounters, community appointments, medication management, and identified SDOHs

Collaborate with healthcare professionals to assess, plan, and coordinate patient care needs

Participate in quality improvement activities to enhance clinical outcomes and resource utilization

Collect and analyze patient information for third-party vendors

Arrange or participate in member case conferences internally at CDCR, externally with GCHP and community agencies

Submit timely progress reports and updated member care plans and profiles as necessary to support continuum in the member’s case management process

Perform telephonic assessment to assess member needs and collaborate with resources and provides education/support for treatment regimen adherence and medication management to support self-management and independent living

Identify potential care gaps and make referrals as appropriate

Identify available community services and health resources and facilitate access to care and services available to patient/family when needed

Collect, document, and maintain all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulations

Make referrals for Complex Case Management, Enhanced Case Management, or Basic Case Management

Provide feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner

Attend all required team/staff meetings

Perform other duties as assigned by people leader to meet business needs

Qualification

Case ManagementRegistered Nurse (RN)Licensed Vocational Nurse (LVN)Licensed Practical Nurse (LPN)Disease ManagementManaged CareBehavioral HealthAdvocacy SkillsSpanish SpeakingEffective Communication

Required

Completion of an accredited Registered Nurse (RN) program or accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program

1-3 years in case management, disease management, managed care or medical or behavioral health settings

Valid RN or LVN/LPN license is required for the job. License must be active, unrestricted and in good standing

A valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation

Preferred

3-5 years in case management, disease management, managed care or medical or behavioral health settings

Spanish speaking preferred

Certified Case Manager (CCM) or Certified in Health Education and Promotion (CHEP)

Company

Clinicas del Camino Real, Inc.

Clinicas del Camino Real, Inc. has been providing quality primary and preventative health care services to the residents of Ventura County since 1971.

Founded in 1971

Camarillo, California, USA

501-1000 employees