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Central California Alliance for Health

Regional Medi-Cal managed care plan

Senior Complex Case Manager - Registered Nurse, D-SNP

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
ContractCalifornia, USA$56 - $63

About the Job

Requirements

  • Current unrestricted Registered Nurse license issued by the State of California.
  • Associate’s degree in Nursing and at least seven years of experience in a patient-care setting, including at least one year of case-management experience; a Bachelor’s degree may substitute for two years of the required experience, or an equivalent combination of education and experience may qualify.
  • At least one year of the required patient-care experience must be in an acute or outpatient environment working with adults and/or dual-eligible populations.
  • Knowledge of clinical nursing principles and practices.
  • Knowledge of case-management principles and practices, including motivational interviewing and evidence-based guidelines.
  • Knowledge of care management and coordination.
  • Knowledge of complex chronic conditions, geriatric care, and psychosocial factors affecting health outcomes.
  • Knowledge of health-improvement strategies addressing social determinants of health.
  • Knowledge of evidence-based practice guidelines for developing care plans.
  • Knowledge of electronic health records and/or care-management platforms.
  • Ability to assess member risk, define problems, develop care plans, and collaborate across disciplines.
  • Ability to interpret and apply policies and regulations.
  • Ability to define issues, conduct research, interpret data, and identify and evaluate options.
  • Ability to evaluate medical records and other health-care data.
  • Ability to organize work, manage complex priorities, and document accurately and promptly.
  • Ability to communicate effectively with a diverse member population, including members with behavioral-health issues.
  • Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future employer-supported sponsorship.

Responsibilities

  • Develop and manage individualized comprehensive plans of care for Medicare Dual Eligible Special Needs Plan members referred to the Case Management Program, promoting optimal, achievable outcomes in the most cost-effective and appropriate manner.
  • Work with and educate members, families, providers, external agencies, and internal departments about the D-SNP Case Management Program.
  • Participate in Quality Improvement studies to evaluate the program’s effectiveness and its ability to promote quality-driven, cost-effective, achievable member goals and outcomes.
  • Perform D-SNP Program oversight and support activities.
  • Act as a liaison between the D-SNP Program, providers, and community agencies to promote effective implementation of program objectives and requirements.

About the Company

Central California Alliance for Health

Regional Medi-Cal managed care plan

Central California Alliance for Health is a regional Medi-Cal managed care plan that provides health coverage for children, adults, seniors, and people with disabilities in Mariposa, Merced, Monterey, San Benito, and Santa Cruz counties, serving over 434,000 members. It works by enrolling members in a Medi-Cal plan and routing care through a network of primary care physicians and clinics to coordinate services and emphasize preventive care and ongoing management. It differs from many competitors through its mission-driven focus on improving access for low-income residents, its long history since 1996, and its community-oriented, network-based approach. Its goal is to pursue Healthy People. Healthy Communities by improving health outcomes and access to care for the communities it serves.

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