Nurse Case Manager I

Overview

To initiate and coordinate a multidisciplinary team approach to case management. Engages the

member / member's representative in a care plan that assists the member in meeting his / her health

and wellness goals. Collaborates, assesses, plans, facilitates, evaluates, and advocates to meet the

comprehensive medical, behavioral, and psychosocial needs of the member, while promoting

quality and cost-effective outcomes.

Responsibilities

• Provides case management services independently for a caseload ranging in complexity

from basic to complex; acuity levels 1-4; performs field-based case management (acuity

level 5) with supervision.

clinical and non-clinical components, and ensuring the care plan is available

to both the member and primary care provider.

Services Integrated Rounds Meetings.

communication with providers, members, and identified health care designee.

members, providers, vendors, community partners, and PHC employees.

member's health status.

modes of care; aids member to connect with community-based organizations to support

and enhance wellness.

guidance, in accordance with identified department service levels.

suitable for case management.

and other departmental activities as assigned.

resource to other staff.

Qualifications

Education and Experience

Associate's degree in Nursing required; Bachelor's degree in Nursing

(or higher) preferred. 2 years of experience preferred, to include at least one (1) year of case management experience and one (1) year in an acute care setting; or equivalent combination of education and

experience. General knowledge of managed care and / or experience

with Medicaid population preferred.

Special Skills, Licenses and Certifications

Current and unrestricted California Registered Nurse License. Valid

California driver's license and proof of current automobile insurance

compliant with PHC policy are required to operate a vehicle and travel

for company business. Bilingual skills in Spanish, Russian, or Tagalog

preferred.

Performance Based Competencies

Strong organizational, communication, critical thinking skills and

attention to detail required. Ability to work within an interdisciplinary

structure and function independently in a fast-paced environment while

managing multiple priorities and meeting deadlines. Effective

telephone and computer data entry skills required. Experience in

managed care business practices and ability to access data information

using various computer systems. Excellent English written and verbal

communication skills required.

Work Environment And Physical Demands

Able to utilize multiple computer platforms simultaneously. Daily use

of telephone and computer for most of the day. Standard cubicle

workstation. Must be able to lift, move, or carry objects of varying size, weighing up to 10 lbs.

All HealthPlan employees are expected to :

HIRING RANGE : $49.54 - $64.41

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change