Medical Case Manager (RN)

Kinetic Personnel Group is currently recruiting a Medical Case Manager (RN) for a $3 billion-dollar a year government public health plan (government agency) is renowned for its work in the community and being a great place to work. This position is a 6 month temporary position (in-office, onsite) that pays between $45/hr - $65/hr depending on experience. This will become a permanent position for the right candidate. A full time permanent position includes a pay raise, telecommute options, a CalPERS Pension and excellent government benefits including generous holiday, PTO and sick pay days off, year one! Position Responsibilities Care Management Assesses member needs using a standardized health needs assessment or health risk assessment. Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of: Member’s physical, functional, social and psychological status Member’s cultural and linguistic needs Caregiver resources and available benefits Performs post-discharge assessments to identify member’s post-hospital or post-emergency department discharge needs including but not limited to: Member’s physical, functional, social and psychological status Member’s cultural and linguistic needs Caregiver resources and available benefits Follow-up provider care and ensuring scheduled appointments Durable medical equipment and supplies Community resources Develops and implements a member’s specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals. Reviews, modifies and updates care plans continuously to reflect the member’s needs, at minimum, annually or upon change in condition. Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goals. Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards. Coordinates care and services with members, members’ family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS). Communicates with member’s physicians, specialists, community agencies and vendors to ensure coordination of services. Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources. Facilitates and participates in Interdisciplinary Team meetings as applicable. Collaborates with interdepartmental staff in case resolution as needed. Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner. Advocates in the member’s best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals. Requirements: Associates degree in Nursing (ADN); or equivalent work experience required. Bachelor’s degree in Nursing (BSN) preferred. Current, unrestricted Registered Nurse (RN) license to practice in the State of California required. 3 years of clinical experience with the health needs of the population served required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying. Utilization management reviewer experience An active Commission for Case Manager (CCM) certification preferred. Understand confidentiality and the legal and ethical issues pertaining to case management. Bilingual Spanish, preferred KPG123