RN Care Manager
Under the direction of the Behavioral Health Director, the Care Manager is responsible for high quality care management activities for Center of Excellence (COE) patients. This includes developing therapeutic relationships with patients, facilitating care coordination and resource linkages, obtaining authorizations for services according to IEHP and other payer policy guidelines, assisting patients in navigating care, and utilizing evidenced based communication skills to facilitate self-management behaviors.
- Establish and maintain effective goodwill relationships with coworkers, supervisors and other colleagues, and collaboratively work with treatment team members.
- Model the highest ethical behavior in relationships with co-workers, supervisors, for patients, and colleagues in the community.
- Model development of therapeutic alliances with patients and support the treatment team to utilize evidenced based communication skills with patients.
- In collaboration with treatment team members, provide high quality care management services to patients: including care coordination, linkage to resources, navigation of health systems and advocacy.
- Support patients in enhancing their self-efficacy and self-management, through evidenced based communication techniques, such as motivational interviewing.
- Conduct telephonic assessments when necessary and provide clinical judgement on needs of patients.
- Develop, strengthen and maintain effective partnering relationships with providers, and other Summit team members.
- Provide support and clinical consultation to providers when needed.
- Provide learning and development activities for providers and care coordinators as needed.
- Engage with provider service leaders and supervisors in developing useful metrics, reports and dashboards to facilitate continuous quality improvement.
- Facilitate in ICT (interdisciplinary Care Team) meetings for patients when needed to develop and update whole person care plans.
- Ensure familiarity with NCQA standards, DMHCS, CMS state/federal regulations and annual measurements as needed to meet IEHP and other payer needs.
- Oversee Care Coordinators to ensure care plans and care coordination activities are carried out in a timely and effective manner.
- Any other duties as required to ensure successful operations.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in policies and procedures related to HIPAA compliance.
- Maintains safe and clean working environment by complying with procedures, rules, and regulations.
- Protects patients and employees by adhering to infection-control policies and HIPAA protocols.
- Upholds companys mission statement & core values
- Other duties as assigned
Active RN License required. Possession of a valid State of California drivers license.
Experience working successfully within a team, and experience in developing and maintaining effective relationships with both clients and coworkers is mandatory. Experience working in case management, or care management positions is preferred. Experience working with a multidisciplinary team is preferred.
Excellent interpersonal skills, and the desire and ability to develop genuine, effective relationships with patients, providers, co-workers, supervisors and community partners. Knowledge of whole health principles, team-based care and of integrated care principles and practices is important. Knowledge, skills and understanding about employee engagement, and the willingness to utilize best practices in this area. Knowledge and skills in working from a strength-based perspective with patients and providers is important. Proficient in the use of computer software to include but not
limited to: (e.g. Microsoft Word and Excel, Power Point). Knowledge of Behavioral Health principles and theories.
Bilingual (English/Spanish) written and verbal is preferred, but not required. Must be able to work independently.
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.
Commitment to Team Culture:
A Team Member demonstrates commitment to team culture, through developing professional and effective working relationships, that include elements of respect, cooperation for team members, patients and associates outside of our organization.Company Description
Who we are:
We are a pain management company that specializes in a multi-disciplinary approach to pain. We are a group of passionate physicians ranging from Anesthesiologists, Nurse Practitioners, Registered Nurses, Acupuncturists, Chiropractors, Psychologists, Psychiatrists, and Physical Therapists. Not only are we passionate about what we do, but why we do it, which is to help people that are in pain and change their quality of life for the better.
We are paving the way to modern medicine and looking for candidates that want to join us in making a difference. Candidates should excel in fast paced environments, express a willingness to learn, be passionate about what they do and ideally have a strong background in pain management. We are rapidly growing and have unique opportunities available.