Specialist Case Manager RN or Social Worker

Location: Westminster, CA
Date Posted: 02-15-2018
Specialist Case Manager
Westminster, CA
The Specialist Case Manager, under the direction of the Supervisor or Manager of Case Management provides direction, identifies health and psychosocial issues of a select member population and assesses, plans, implements, coordinates monitors and evaluates services and outcomes to ensure maximized health of the member. Assumes a leadership role within the interdisciplinary care team to achieve optimal clinical and resource outcomes.   
 ESSENTIAL DUTIES AND RESPONSIBILITIES 
  • Identifies issues relating to members' physical and mental well-being that affects health status and works in collaboration with both the member and provider to determine appropriate care for case management services.
  • In collaboration with the member and PCP completes a comprehensive assessment and develops a care plan assessing short-term and long-term needs.
  • Acts as a leader during interdisciplinary care team conferences to achieve optimal clinical and resource outcomes.
  • Interacts continuously with member, family, physician(s) and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan.
  • Maintains and documents initial assessment; designs a care plan that is attainable and in the appropriate business application program.
  • Acts as a liaison between physician and member to alleviate potential issues that can interrupt care
  • Maintains case load by identifying cases that are no longer high in intensity or services and closes them timely and appropriately.
  • Schedules or facilitates scheduling appointments and follow-up services; requests consultation and diagnostic reports from network specialists; contacts members to remind them about upcoming appointments and/or missed appointments.
KNOWLEDGE, SKILLS, ABILITIES 
  • Experience in CM or other managed care environment.
  • Knowledge of disease specific states, clinical and community resources.
  • Strong critical thinking and problem solving skills.
  • Ability to network, advocate, communicate assertively with all customers.
  • Work involving high volume and strict timeframes.
  • Excellent communication skills.
  • Exceptional organizational skills especially while multitasking. Ability to drive multiple projects a plus.
  • Ability to work in fast paced environment.
  • Works well independently as well as part of a team.
  • Strong commitment to help others.
  • Computer literate; must have experience working with a Medical Management platform. MS Word, Excel, Outlook a plus
   EDUCATION / EXPERIENCE 
  • Minimum Education: LMSW or  RN
  • Licensure:  Licensure must be current and unrestricted in the appropriate jurisdiction
  • Preferred Education: BA or BS in Nursing, MSW in Social Work
  • Minimum Experience:
    • 2+ years of experience in a clinical acute care position, preferably in home health, physician’s office or public health
  • Preferred Experience:
    • 1 to 3 years disease management, case management or formal patient education experience;
    • CCM Certification
or
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