1 Job in San Jose, CA
Santa Clara Family Health Plan is Hiring a RN Case Manager Near San Jose, CA
The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.
FLSA Status: Exempt
Department: Health Services
Reports To: Health Services Management
Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521
General Description Of PositionThe RN Case Manager is responsible for providing on-going case management services for Santa Clara Family Health Plan (SCFHP) members. As a SCFHP member advocate, the RN Case Manager facilitates communication and coordination among all participants of the care team to ensure member identified goals and needed services are provided to promote quality cost-effective outcomes. Through the development and implementation of member individualized care plans, the RN Case Manager provides medical and psychosocial case management support to help coordinate resources and services for individuals across the healthcare and social services continuum, and facilitate the use of available healthcare benefits in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements.
Essential Duties And ResponsibilitiesTo perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.
- Conduct, review and document comprehensive clinical and/or psychosocial assessments and on-going follow-up interventions to measure progress towards meeting goals as they relate to a member’s physical, psychosocial, environmental, safety, developmental, cultural and linguistic needs.
- Maintain case files by assuring that they are documented in accordance with SCFHP policies and procedures, state and federal requirements and organized in a manner that adheres to standards for audit requirements.
- Facilitate involvement of the member and/or family/responsible party for development and implementation of a member specific care plan which includes individualized prioritized goals.
- Coordinate member’s care with PCP, Specialists, Behavioral Health and Long Term Services and Supports providers to assist member to achieve or maintain a level of functional independence which allows them to remain at home or in the community.
- Facilitate and coordinate communication with member’s interdisciplinary care team including SCFHP internal staff, as well as the member’s physicians, specialists, public services, community agencies and vendors to ensure care plan development and coordination of benefits and services.
- Facilitate successful transition of care for members who move between care settings by coordinating services for medical appointments, pharmacy assistance and by facilitating utilization review.
- If assigned to MLTSS, support the transition of long-term care members residing in nursing facilities to a lower level of care, or community setting in partnership with MLTSS providers and programs.
- If assigned to Community Based Adult Services (CBAS):Conduct face-to-face, on-site eligibility determinations for CBAS services with members using the standardized California Department of Health Services approved tool – CBAS Eligibility Determination Tool (CEDT) & Patient Health Record Quick Guide; Review and approve Individual Plan of Care for CBAS members; and Provide care coordination to targeted CBAS members including assessment, care plan implementation and care transitions.
- Conduct telephonic and/or visits/assessments, as needed in the home, facility or community setting.
- Collaborate with team members on cross-departmental improvement efforts, quality improvement projects, optimization of utilization management, and improvement of member satisfaction.
- Attend and actively participate in Health Services meetings, operational meetings, training and coaching sessions, including off-site meetings as needed.
- Perform other duties as required or assigned.
- Active California RN License without restriction. (R)
- Minimum three years of experience in case management, discharge planning, or education or certifications, or equivalent experience. (R)
- Knowledge of managed care principles and practices with emphasis in Utilization Management and/or Case Management. (R) Clinical knowledge and critical thinking skills with the ability to assess individualized whole-person care needs necessary to develop an effective care plan. (R)
- Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R)
- Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D)
- Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities, children). (D)
- Ability to work within an interdisciplinary team structure. (R)
- Ability to conduct home, facility and other community-based visits. (R)
- Maintenance of a valid California driver’s license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)
- Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the operations as dictated by business needs. (R)
- Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R )
- Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
- Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing as mandated by nursing scope of practice. (R)
- Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
- Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
- Ability to maintain confidentiality. (R)
- Ability to comply with all SCFHP policies and procedures. (R)
- Ability to perform the job safely and with respect to others, to property and to individual safety. (R)
Physical RequirementsIncumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:
- Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
- Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
- Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
- Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)
- Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
- Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)
EOE
Job Summary
Full Time
Ancillary Healthcare
$107k-129k (estimate)
04/12/2023
07/07/2024
scfhp.com
SAN JOSE, CA
200 - 500
1997
MINORU YAMATE MD
<$5M
Ancillary Healthcare
Related Companies
The job skills required for RN Case Manager include Case Management, Coordination, Discharge Planning, Managed Care, Communication Skills, Critical Thinking, etc. Having related job skills and expertise will give you an advantage when applying to be a RN Case Manager. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by RN Case Manager. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for RN Case Manager positions, which can be used as a reference in future career path planning. As a RN Case Manager, it can be promoted into senior positions as a Case Management Director that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary RN Case Manager. You can explore the career advancement for a RN Case Manager below and select your interested title to get hiring information.
If you are interested in becoming a RN Case Manager, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a RN Case Manager for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on RN Case Manager job description and responsibilities
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Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
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Graduate from an Accredited Nursing Program.
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Gain Experience Working as a Nurse.
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Step 3: View the best colleges and universities for RN Case Manager.
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