Department(s): Case Management
Reports to: Manager, Case Management
FLSA status: Non-Exempt
Salary Grade: K - $70,000 - $114,268
Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is on Wednesday, January 24, 2023 at 11:59 PM. Applicants are encouraged to apply early.
About CalOptima Health
CalOptima Health serves one in three residents in Orange County with health insurance programs for low-income children, adults, seniors, and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition, and opportunities to grow.
About the Position
The Care Manager will facilitate communication and coordination among all participants of the health care team and the member to ensure quality and cost-effective outcomes. Responsibilities include providing intensive case management, which encompasses assessment, planning, implementation, coordination, monitoring, and evaluation of the member’s needs.
Duties & Responsibilities:
- Participates in a mission-driven culture of high-quality performance, focusing on customer service, consistency, dignity, and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support department goals.
- Assesses member needs using standardized health needs assessments.
- Performs comprehensive clinical assessments of all identified cases, including:
- Member’s physical, functional, social, and psychological status
- Member’s cultural and linguistic needs
- Caregiver resources and available benefits
- Develops and implements a member-specific care plan with prioritized goals.
- Schedules follow-ups to assess progress towards goals and identifies barriers.
- Provides outreach to assigned members and evaluates service quality.
- Coordinates care with members, family members, and other providers.
- Communicates with physicians, specialists, and community agencies to ensure service coordination.
- Facilitates referrals to behavioral health services and community resources.
- Documents all case interventions according to protocol.
- Facilitates interdisciplinary team meetings as applicable.
- Collaborates with interdepartmental staff in case resolution.
- Identifies cases needing higher-level review and routes accordingly.
- Maintains appropriate documentation of patient care and progress.
- Advocates for members’ best interests regarding funding and treatment.
- Reports productivity metrics to supervisor.
- Completes other projects and duties as assigned.
Experience & Education:
- Bachelor’s degree in social work, psychology, gerontology, public health, or related field required.
- 5 years of clinical and/or managed care experience required.
- An equivalent combination of education and experience is qualifying.
- Valid driver’s license and vehicle or approved transportation required for work away from the primary office 20% of the time or more.
Preferred Qualifications:
- Licensed Vocational Nurse, Registered Nurse, or master’s degree in a related field.
- Certified Case Manager (CCM) certificate.
- Bilingual in English and one of CalOptima Health's defined threshold languages.
Physical Demands and Work Environment:
- Physical demands: Employee must be able to sit for extended periods and work at a computer for long periods. Employee is required to use hands for typing and communication.
- Work Environment: Employee will have one-on-one contact with members in various settings and is expected to use diplomacy and problem-solving skills.
About our Benefits & Wellness options:
CalOptima Health offers a comprehensive benefits package, including participation in CalPERS, low-cost medical/vision/dental insurance, and paid time off. Flexible scheduling and telework options are available.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, creating an inclusive and equitable workplace.
CalOptima Health is an equal employment opportunity employer and prohibits unlawful discrimination against any employee or applicant.
If you are a qualified individual with a disability, you may request a reasonable accommodation.
Required Skills:
- Possesses critical thinking and problem-solving skills.
- Effective oral and written communication skills.
- Effective interpersonal relationship skills.
- Ability to utilize computers for documentation purposes.
- Bilingual English/Spanish preferred.
- Ability to read and comprehend English at a level necessary to follow instructions.
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