Case Manager Rn - San Diego, United States - Integrated Health Partners of Southern California

Description

JOB DESCRIPTION

JOB TITLE:
Social Case Manager-RN


COMPANY:
Integrated Health Partners


REPORTS TO:
Assistant Clinical Director


DIRECT N/A


REPORTS:
Healthcare Liaison


STATUS:
Exempt FULL TIME


WORK COMP CLASS:8810


OUTSIDE TRAVEL 50%


WORK CONDITIONS:
Hybrid


TRAVEL:7-7/M-F

This job description is intended to be a general statement about this job and is not to be considered a detailed assignment.

It may be modified at any time, with or without advance notice, to meet the needs of the organization.


JOB SUMMARY

Under the direction of the Assistant Clinical Director, the position is responsible for facilitating and coordinating care management services to the network that include care coordination and facilitation activities that promotes the quality and cost of care.

The position is responsible for assessing patients' needs and developing an executable plan to help patients navigate the social barriers to achieving good care, The position will work closely with LVN and Health care liaisons to ensure plan of care is executed and patient receive the right care at the right time with the right outcome and right patient experience.

The position will focus on the Enhanced Care Management patient population (ECM).

The Enhanced Care Management program (ECM) is a new statewide Medi-Cal benefit available to eligible members with complex needs, including access to a support team that provide comprehensive care management and coordinate health and health-related care and services.

ESSENTIAL JOB FUNCTIONS

Case Management

• Identify at risk populations and enroll patients that need assistance with social and clinical coordination necessary to improve quality of care and control cost for patients attributed to IHP's network.
• Complete comprehensive assessments on patients that have been identified for care to include a plan to specifically address including, but not limited to, physical and developmental health, mental health, dementia, SUD, LTSS, oral health, palliative care, necessary communitybased and social services, and housing.
• Develop personalized care plans for each patient outlining a wholeperson approach to address the services and resources needed to improve the patient's health.
• Coordinate care with health centers to ensure there is a cohesive plan to help patients achieve optimal health outcomes.
• Effectively delegates interventions outlined in the plan of care to the HC liaison and SCM/LVN
• Review payer and Arcadia quality performance reports to identify the quality metrics that are performing below performance thresholds and develop and implement clinical action plans to address gaps in care, access, and/or quality outcome issues.
• Work with clinicians and key stakeholders to develop, maintain and monitor the implementation of the care management strategies that support enhanced care management.
• Evaluate clients progress making adjustments to plan of care as needed to improve outcomes.
• Prepare case related reports that include clinical summary, barriers to goals, outcomes, and prognosis.
• Follow up on client referrals to ensure that clients can access and receive necessary services in a timely manner.
• Coordinate and provide care that is safe, timely, effective, efficient, equitable, and client centered.
• Manage a caseload patient ensuring that assessments and re assessments are completed timely.

Utilization Management

• Work with the health centers to review utilization patterns of identified high risk patients and identify improvement plans to improve areas.
• Partner with payers to design UM processes to improve facilitybased events (ED/IP) to ensure proper utilization and outcomes. Ensuring care is continuous and integrated among all service providers.
• Ability to develop strategies to reduce avoidable patient admissions and readmissions.
• Develop and update discharge planning including coordinating follow up care and support services to facilitate safe transition home.

Coding & Documentation Integrity

• Provide clinical guidance on coding or documentation audits performed by the Coding & Documentation Integrity Team.

Other

• Develop team members and create tools to ensure strong teams and processes are in place for success.
• Meet annual goals outlined by leadership that align with the network strategic plan.
• Establish and maintain collaborative working relationships with community resources.
• Actively participate in staff meetings and training.
• Perform other duties as assigned.

QUALIFICATIONS

Education/Experience

• RN, or LCSW license required.
• CCMC, or equivalent, certification preferred.
• Must have 23 years clinical experience: 3+ years preferred.
• Working knowledge of regional health disparities and social determinants of health.
• Working knowledge of Medi-Cal regulations and Enhanced Care Management.
• Must have strong interpersonal skills to work effectively internally and