Saviance · 4 months ago
Healthcare - Case Manager III
CA
Full-time
Hybrid
Senior Level
5+ years expSaviance is a healthcare management company seeking a Case Manager III to oversee the health care management and coordination of Molina Healthcare members. The role involves creating and implementing collaborative care plans, conducting assessments, and ensuring compliance with regulations to achieve optimal outcomes for members.
Information Technology & Services
Responsibilities
Responsible for health care management and coordination of Molina Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes
Works with members to create and implement an integrated collaborative plan of care
Coordinates and monitors Molina member's progress and services to ensure consistent cost effective care that complies with Molina policy and all state and federal regulations and guidelines
Provides case management services to members with chronic or complex conditions including: Proactively identifies members that may qualify for potential case management services
Conducts assessment of member needs by collecting in-depth information from Molina's information system, the member, member's family/caregiver, hospital staff, physicians and other providers
Identifies, assesses and manages members per established criteria
Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs
Performs ongoing monitoring of the plan of care to evaluate effectiveness
Documents care plan progress in Molina's information system
Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes
Measures the effectiveness of interventions to determine case management outcomes
Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Molina members
Conducts face to face or home visits as required
Maintains department productivity and quality measures
Manages and completes assigned work plan objectives and projects in a timely manner
Demonstrates dependability and reliability
Maintains effective team member relations
Adheres to all documentation guidelines
Attends regular staff meetings
Participates in Interdisciplinary Care Team (ICT) meetings
Assists orientation and mentoring of new team members as appropriate
Maintains professional relationships with provider community and internal and external customers
Conducts self in a professional manner at all times
Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct
Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth
Complies with required workplace safety standards
Qualification
Required
RN
Must live in CA (San Diego area)
Strong computer skills as this job requires being able to navigate different systems
Organization as there is a lot of work and very independent
Health literacy – as this position is for a CM so they will need to be able to assess/understand different physical and mental health diagnoses/symptoms and educate members
Bachelor's degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree)
5-7 years of clinical experience with case management experience
Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing
Must have valid driver's license with good driving record and be able to drive locally
Preferred
Prefer 3 years of experience, but open to someone with less years, depending on what work they have been doing
Company
Saviance
Saviance is a modern consulting firm providing a variety of professional services to its clients in the US.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Rohit M.
Managing Partner
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