High Intensity Case Manager
Company: Prospect Medical
Posted on: July 15, 2019
High Intensity Case Manager
Prospect Medical Systems - CA
High Intensity Case ManagerWe are hospitals and affiliated medical
groups, working closely together for the benefit of every person
who comes to us for care. We build comprehensive networks of
quality healthcare services that are designed to offer our patients
highly coordinated, personalized care and help them live healthier
lives. Through collaboration, we strive to provide all of our
patients and medical group members with the quality, affordable
healthcare they need and deserve.
The scope of the High Risk Case Manager is to effectively manage
members on an outpatient basis to ensure the appropriate
level-of-care is provided for complex and chronic care needs by
assessing, developing, implementing, coordinating, monitoring, and
evaluating care to prevent re-admissions and ensure that the
members' medical, environmental and psychosocial needs are optimize
over the continuum of care.Job Responsibilities/Duties
- Identifies appropriate members for case management and conducts
assessments to identify individual needs and a specific care
management plan to address objectives and goals as identified
- Develop an Initial Care Plan (ICP) by conditions identified in
healthplan HRA, patient assessment, medical records
authorizations/referrals, primary care physician, member and
Interdisciplinary Care Team (ICT).
- Setting members prioritized and self-management goals.
- Case Manager's ability to manage a caseload consisting of a mix
of chronic and high risk members.
- Collaborate with Nurse Practitioner, Pharmacist, PCP, SPC
healthplans and other IDT members.
- Require a minimum of 12-15 member contacts daily to assess and
- Create and manage all cases in Essette for members requiring
case management and members that are in a MOC.
- Provides appropriate documentation including but not limited
to; cognitive, functional, ADL, environmental factors,
psychosocial, medical and benefits ect.
- Conducts outbound calls to assign high risk or chronic case
- Collaborate with member's family and physicians for seamless
coordination of care and services.
- Collaborate and coordinate care with healthplans, Community
Based Programs (CBAS), Multiple Long Term Support Services (MLTSS)
and Behavioral Health providers.
- Meet healthplans and NCQA requirements in turn-around-time for
assessments, careplans and IDTs.
- Monitors and evaluate effectiveness of the care management plan
and modifies as necessary to meet NCQA requirements to include all
- Interfaces with Medical Director and attends IDT as
QualificationsMinimum Education: High School diploma or Associate
Minimum Experience: Two (2) years experience in case management
preferably in a medical group or health plan setting.
Req. Certification/Licensure: Registered Nurse or Licensed Vocation
Nurse unrestricted active license required.Employee Value
PropositionProspect Medical Holdings, Inc., is guided by a diverse
and highly experienced leadership core. This group maintains the
vision that has made Prospect a needed difference-maker in the
lives of so many patients today, and many executives contribute to
our continued efforts. As a member of our highly effective team of
professionals you will receive:
- Company 401K
- Medical, dental, vision insurance
- Paid time-off
- Life insurance
Prospect Medical Systems has a zero-tolerance policy regarding the
use of drugs and alcohol. Our Company is committed to maintaining a
productive, drug free workplace that keeps employees and patients
safe from harm. For this reason, we require applicants to pass a
screening for drug use as a condition of employment. This includes:
alcohol, marijuana, cocaine, opiates and methamphetamines.How to
ApplyTo apply for this role, or search our other openings, please
visit http://pmh.com/careers/ and click on a location to begin your
journey to a new career with us!
We are an Equal Opportunity/ Affirmative Action Employer and do not
discriminate against applicants due to veteran status, disability,
race, gender, gender identity, sexual orientation or other
protected characteristics. If you need special accommodation for
the application process, please contact Human Resources.
EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm
Keywords: Prospect Medical, Orange , High Intensity Case Manager, Executive , Orange, California
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