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High Intensity Case Manager - Temp in Orange at Prospect Medical Systems

Date Posted: 6/6/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    600 City Parkway West
    Orange
  • Experience:
    Not Specified
  • Date Posted:
    6/6/2018
  • Job ID:
    9704

Job Description



High Intensity Case Manager

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The scope of the High Intensity Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members’ medical, environmental and psychosocial needs are optimize over the continuum of care. Care plan sign off by RN when mandated by health plan requirements.



Job Responsibilities/Duties

  • Identifies appropriate members for case management and conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
  • Develop Initial Care Plan (ICP) by conditions identified in healthplan HRA, patient assessment, medical records authorizations/referrals, primary care physician, member and Interdisciplinary Care Team (ICT). Setting members prioritized and self-management goals.
  • Case Manager’s ability to manage a panel/caseload of 80-100 chronic and high risk members in collaboration with Nurse Practitioner, Pharmacist, PCP, SPC, healthplans and other IDT members.
  • Require 15-20 member contacts daily to assess and coordinate care.
  • Create cases in Essette for each case managed member with appropriate documentation including but not limited to; cognitive, functional, ADL, environmental factors, psychosocial, medical and benefits ect.
  • Monitors and evaluate effectiveness of the care management plan and modifies as necessary to meet NCQA requirements to include all required elements.
  • Interfaces with Medical Director and attends IDT as required.
  • Conducts outbound calls to assigned high risk or chronic case managed members.
  • Collaborate with member’s family and physicians for seamless coordination of care and services.
  • Collaborate and coordinate care with healthplans, Community Based Programs (CBAS), Multiple Long Term Support Services (MLTSS) and Behavioral Health providers.
  • Meet healthplans and NCQA requirements in turn-around-time for assessments, careplans and IDTs.


Qualifications

Minimum Education: High School graduate required; Associate in Arts degree preferred.

Minimum Experience: At least two (2) years experience in ambulatory case management, preferably in a medical group or health plan setting. Strong clinical background must be familiar with developing care plans and completing comprehensive assessments.

Req. Certification/Licensure: Unrestricted Active RN or LVN.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance


How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: Case Manager, Case Management, MGMT, Patitent Admission, Readmission, Care Plan, Care Planning.

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