Outpatient Case Manager
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Job Description
Outpatient Case Manager coordinating patient care and overseeing the care of patients receiving medical services. Joining a diverse and supportive team in a growing healthcare organization offering flexible work arrangements.
Responsibilities:
- Coordinate and oversee the care of patients receiving outpatient medical services.
- Identification of members appropriate for case management, based on identification of health-related problems.
- Assessing members physical and psychosocial needs/barrier.
- Developing the case management care plan.
- Developing and implementing the interventions needed to resolve barriers and coordinate care.
- Documenting assessments, care plan interventions, and all other activities related to coordinating the care of the case managed members.
- Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.
- Maintain department procedure/policy standards with regards to turnaround time, etc.
- Support the interdisciplinary team approach to ensure effective resource utilization, as well as quality and cost-effective outcomes.
- Coordinate resources for members.
- Document all case management activities in the Ezcap system.
- Utilize reports and systems to identify and monitor utilization patterns and facilitate needed care coordination.
- Attend Interdisciplinary meetings and team meetings.
- Manage the cases to include case management and transition of care activities.
Requirements:
- Current CA & TX/Multi State LVN or RN licensure.
- CM and/or UM training and/or certification.
- Knowledge of CM standards, UM standards, Clinical Standards of Care, NCQA requirements, CMS guidelines, Milliman guidelines, and InterQual guidelines.
- Medi-Cal, Commercial and Medicare contracts and benefit interpretation is preferred.
- Five years+ clinical experience.
- Prefer of two (2) years+ experience in an HMO/IPA/Managed care setting is preferred and recommended.
- Excellent communication, interpersonal, and problem-solving skills, with the ability to interact effectively with patients, families, and healthcare professionals.
- Ability to work independently and collaboratively in a fast-paced environment, prioritizing tasks and managing multiple responsibilities effectively.
- Commitment to patient-centered care, cultural competence, and ethical practice.
- Process oriented.
- Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe.
- Detail oriented and highly organized.
- Strong ability in problem-solving.
- Ability to self-manage, strong time management skills.
- Ability to work in an extremely confidential environment.
- Strong written and verbal communication skills.
Benefits:
- 100% employer paid medical, vision, dental, and life coverage for employees.
- Additional employee paid coverage options available.
- Paid holidays.
- Birthday off.
- Unlimited PTO.
- 401k plan.
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