Description
Summary- The Care Management Specialist is primarily responsible for the overall coordination of the Direct Lines of Business programs for Health Plan members.
- Responsibilities include program development, technology implementation and integrity, ensuring regulatory and accreditation compliance, program utilization and outcome reporting.
- The position is also responsible for assuring all functions are operating in accordance with the organization's mission, values and strategic goals; are focused on continuous improvement and provided in a manner that is responsive and culturally sensitive to the needs of diverse membership.
- In collaboration with the Primary Care Provider (PCP) and other treatment professionals, performs telephonic physical, functional and psycho-social assessments
- Assesses readiness to change, develops and maintains a member/family specific individualized care plan developed using evidenced based guidelines
- Approved clinical practice guidelines or protocols to determine variance from expected outcomes, linking member/family to resources within and outside the health care system and community, and researches all potential resources if gaps exist for that member within their service continuum, continuously maintaining an advocacy position.
Qualifications
- Associate or Bachelor's Degree in Nursing or, Health Administration, Public Health or related healthcare field.
- Master's Degree in Nursing, Health Administration, Public Health or related healthcare field desired
- Bilingual Spanish Highly desired
- Current, active, unrestricted California Registered Nurse license
- Case Management Certification
- Public Health Nursing certification