- Research and design treatment /care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type.
- Initiation of timely individualized care plans (ICP) based on health risk assessment (HRA) completion, participation in and documentation of interdisciplinary meetings (ICT), assisting in transitions of care across all ages.
- Determines appropriateness of referral for CM services, mental health, and social services.
- Provides Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD).
- Conducts member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental cases.
- Manages member treatment in order to meet recommended length of stay. Ensures DC planning at levels of care appropriate for the members needs and acuity.
- Assessment: Assesses members health behaviors, cultural influences and clients belief/value system. Evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriers.
- Research opportunities for improvement in assessment methodology and actively promotes continuous improvement. Anticipates potential barriers while establishing realistic goals to ensure success for the member, providers and BSC.
- Determines realistic goals and objectives and provides appropriate alternatives. Actively solicits client's involvement.
- Planning: Designs appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes. Adjusts plans or creates contingency plans as necessary.
- Assesses and re-evaluates health and progress due to the dynamic nature of the plan of care required on an ongoing basis. Initiates and implements appropriate modifications in plan of care to adapt to changes occurring over time and through various settings.
- Develops appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes.
- Recognizes need for contingency plans throughout the healthcare process.
- Develops and implements the plan of care based on accurate assessment of the member and current of proposed treatment.
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Case Manager
2 weeks ago
WestCoast Children's Clinic Oakland, United StatesWestCoast Children's Clinic, located in Oakland, California, is a non-profit community psychology clinic that provides mental health services to Bay Area children, youth and families. Working at WestCoast Children's Clinic means being part of an organization that is client-cente ...
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Case Management
3 weeks ago
Blue Shield of California Oakland, United States Full timeYour Role · The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurse ...
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Case Management
2 weeks ago
Blue Shield of California Oakland, United States Full timeYour Role · The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurse ...
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Case Management
1 week ago
Blue Shield of California Oakland, United States Full timeYour Role · The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you ...
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Case Manager
1 week ago
PG&E Corporation Oakland, United StatesRequisition ID # · Job Category: Government and Regulatory Relations · Job Level: Individual Contributor · Business Unit: Corporate Affairs · Work Type: Hybrid · Job Location: Oakland · Department Overview · The Regulatory Affairs organization supports the operating lines ...
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Case Manager
6 days ago
Oakland Unified School District Oakland, United StatesRef: PCN9072 · The District and SEIU 1021 are working together to create promotional opportunities for existing staff, therefore this job posting is available for five(5) days for internal candidates based on our collective bargaining agreement. · TITLE: · Case Manager · REPO ...
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Case Manager
5 hours ago
Blue Shield Of California Oakland, United StatesThe Behavioral Health Registered Nurse Case Manager will report to the FEP Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the members needs. The Federal Em Behavioral Health, Case Manage ...
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Case Manager
2 weeks ago
Telecare Corporation Oakland, United States· Case Manager - Substance Use Counselor - Mental Health 355 · "They made it easier for me to live, breathe, eat, and stay clean. Without them, I'd be waiting somewhere, waiting for someone to give me a chance to live..." - Client from Telecare What You Will Do to Change Lives ...
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Case Manager
1 week ago
WestCoast Children's Clinic Oakland, United StatesJob Description · Job DescriptionWestCoast Children's Clinic, located in Oakland, California, is a non-profit community psychology clinic that provides mental health services to Bay Area children, youth and families. Working at WestCoast Children's Clinic means being part of an o ...
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Case Manager
6 days ago
Lao Family Community Development, Inc. Oakland, United StatesJob Description · Job DescriptionLao Family Community Development, Inc. (LFCD) is a community development non-profit agency established in the City of Richmond in Contra Costa County in 1980. Today Lao Family has expanded its operations and service footprint to two additional cou ...
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Case Manager
5 days ago
UCSF Benioff Children's Hospital Oakland Oakland, United StatesJob Description: · The Family Partner is an integrated member of the Mental Health Team, bringing a parent/caregiver perspective into all aspects of the treatment. This is accomplished both internally within the person's primary agency and externally by representing the value of ...
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Case Manager I
2 weeks ago
La Clínica de La Raza Oakland, United States Temporary Full timeAbout the position: Under the supervision of the Site Manager and Clinical Supervisor, the Case Manager works actively to mitigate the social determinants of health that disproportionately impact our patient population. As an essential member of the primary care team, the role o ...
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Case Manager
5 days ago
Children's Hospital & Research Center Oakland Oakland, United States**Job Description:** The Family Partner is an integrated member of the Mental Health Team, bringing a parent/caregiver perspective into all aspects of the treatment. This is accomplished both internally within the persons primary agency and externally by representing the value of ...
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Senior Case Manager
1 day ago
MidPen Housing Oakland, United StatesESSENTIAL DUTIES · Program Efficacy & Efficiency · Provides timely and high-quality coaching to regional staff and manages crisis situations with residents that have supportive needs · Supports direct case management services across multiple sites for identified residents who e ...
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Clinical Case Manager
6 days ago
Bonita House Oakland, United StatesJob Title: Clinical Case Manager · Pgm/Dept: Supported Independent Living / Outpatient Case Management · Reports to: Program Director · Classification: Regular, Full-Time, FLSA Exempt · Pay Range: $70,000 - $80,000 annualized · Location: Oakland, CA 94609 · Schedule: Monday ...
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Senior Case Manager
1 week ago
PG&E Corporation Oakland, United StatesRequisition ID # · Job Category: Government and Regulatory Relations · Job Level: Individual Contributor · Business Unit: Corporate Affairs · Work Type: Hybrid · Job Location: Oakland · Department Overview · The Regulatory Affairs organization supports the operating lines ...
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Case Manager II
1 week ago
Telecare Corp. Oakland, United States"They made it easier for me to live, breathe, eat, and stay clean. Without them, I'd be waiting somewhere, waiting for someone to give me a chance to live..." - Client from Telecare · What You Will Do to Change Lives · Under direct supervision, the Case Manager II serves as a pri ...
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Case Manager II
1 week ago
Telecare Corp. Oakland, United States"They made it easier for me to live, breathe, eat, and stay clean. Without them, I'd be waiting somewhere, waiting for someone to give me a chance to live..." - Client from Telecare · What You Will Do to Change Lives · Under direct supervision, the Case Manager II serves as a pri ...
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Case Manager II
1 week ago
LifeLong Medical Care Oakland, United States· Case Manager II - Supportive Housing Program (temporary) · Job Locations · US-CA-Oakland · ID · Overview · The Case Manager II (CM II), a key member of the primary care interdisciplinary team, provides services for patients with complex care needs. This position conducts patie ...
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RN Case Manager
16 hours ago
Crossroads Home Health and Hospice Oakland, United StatesJob Description · Job DescriptionAbout the Role: · We are seeking a highly skilled RN Case Manager RNCM Hospice to join our team in the Health Care Services industry. As an RN Case Manager RNCM Hospice, you will be responsible for providing end-of-life care to patients in hospice ...
Case Management - Oakland, United States - Blue Shield of California
Description
Your Role
The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including coordination of care with specialists, community resources. Care Managers perform a blended function of utilization management (UM) and care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians.
Your Work
In this role, you will:
