The Health Plan of San Mateo (HPSM), a managed care health plan for Medi-Cal, Healthy Families, Healthy Kids, CareAdvantage, HealthWorx, and San Mateo ACE programs, seeks a Care Coordination RN Case Manager to perform comprehensive assessments, develop individualized care planning, initiate and coordinate case conferences with providers of service, make medical determinations regarding appropriateness of service and determine medical necessity of services requiring prior authorization. Responsibilities also include identification and coordination of short and/or long term needs of catastrophically/chronically ill and/or injured persons and their families. Case Managers coordinate clinical needs across the continuum of care by contacting and establishing links with physicians and other providers and community resources. There is currently a regular full-time position available.
Primary duties: Perform comprehensive assessments and care planning. Communicate with member and/or family/responsible party to initiate and develop individualized care plans. Contact identified high risk members and member families to establish plan of care with understanding of goals as developed with PCP; provide clinical and liaison services, including follow-up of discharge from ER and acute/skilled inpatient admissions. Assist members with appointments for specialists, educational classes, and transportation. Contact healthcare provider to establish medical record, plan treatment and develop documentation of care plan. Make referrals to various departments for necessary involvement i.e. Care Coordination, Disease Management, Health Education, Quality Management and Provider Services when medical condition or needs are appropriate. Review prior authorization requests for medical necessity utilizing established Medicare and Medi-Cal guidelines.
Requirements: A valid California license as a Registered Nurse and two years clinical nursing experience, or equivalent. PHN preferred. Bachelor’s degree in nursing or a related health or social services field is a plus. Certification as CCM (Certified Case Manager) or equivalent is preferred. Geriatric experience and familiarity with community resources helpful. Strong working knowledge of case management, Medicare, and Medi-Cal benefits, as well as the complexities of working with the elderly and disabled populations. Ability to work efficiently with people in varying positions. Ability to gain consensus on resolution of problems. Skill to provide excellent customer service, effectively communicate both verbally and in writing, and problem solve independently. Experience utilizing personal computer and with Microsoft Office products (Word, Excel, Access and Outlook). Ability to work independently in most instances, requiring limited supervision. Knowledge of community resources. Incumbents must have own vehicle and valid driver’s license with proof of insurance in conformity with state law minimums as these positions may require traveling. Bilingual skills (Spanish, Tagalog or Chinese) highly preferred.
Excellent benefits package offered, including HPSM paid premiums for medical, dental, vision, life, AD&D, STD, and LTD insurance; 457 Plan in lieu of social security (7.5% of salary/HPSM paid); retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.
To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 701 Gateway Blvd., Suite 400, South San Francisco, CA 94080. Email: careers@hpsm.org Fax: (650) 616-8039 File by: Continuous until filled. EOE
- Compensation: Negotiated with hiring manager.
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