Clinical Care Manager at Health Plan of San Mateo

, California, United States -

Full Time

Start Date

Immediate

Expiry Date

02 Jan, 26

Salary

0.0

Posted On

04 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Experience, Care Coordination, Assessment Skills, Interdisciplinary Collaboration, Communication Skills, Cultural Competency, Conflict Resolution, Knowledge of Medicare, Knowledge of Medi-Cal, Community Resource Knowledge, Care Transitions, HIPAA Compliance, Bilingual Skills, Documentation Skills, Quality Improvement, Member-Centric Approach

Industry

Hospitals and Health Care

Description

Please Note: HPSM does not typically offer relocation assistance. We are only hiring candidates who currently reside in California. General Description The Clinical Care Manager will perform comprehensive assessments, develop individualized care planning, initiate, and coordinate interdisciplinary case conferences with providers of service, support members in creating and adhering to person-centered care plans. Additionally, the Clinical Case Manager will be coordinating services with other departments, providers, programs, and community partners, as needed, to provide support. Qualifications The following represents the typical way to achieve the necessary skills, knowledge and ability to qualify for this position: Education and Experience Bachelor’s or associate degree. Two (2) years clinical experience. Three (3) years of managed care experience preferably in Care Coordination. Experience working with the health needs of the population served. At least one year of direct Care Coordination experience. Valid California license as a RN, LCSW, LMFT. PHN preferred. Will consider unlicensed master’s Level Social Worker (MSW/ASW). Certification as Certified Case Manager (CCM) preferred. Knowledge Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint. Case management principles and practices. Strong knowledge of Medicare and Medi-Cal programs and benefits. Advanced knowledge of community resources. Complexities of working with the elderly, vulnerable and disabled populations. Expanded knowledge of social determinants of health. Understanding and familiarity of care transitions and discharge planning. HIPAA and other applicable federal and state regulations for confidentiality. Abilities Adapt to changes in requirements/priorities for daily and specialized tasks. Work autonomously and be directly accountable for practice of case management. Work collaboratively with others. Work as part of a team and support team decisions. Utilize member-centric approach to care coordination. Function effectively in a fluid, dynamic, and rapidly changing environment. Influence and gain consensus on individual and group decision-making. Skills Demonstrate member, provider and interdisciplinary team focused interpersonal skills. Work effectively with people in varying positions and diverse backgrounds, by maintaining cultural competency knowledge and practice. Communicate effectively through written, verbal and listening communication skills. Conflict resolution, assertiveness, and collaboration skills Bilingual skills highly preferred, particularly Spanish, Tagalog or Chinese. Licensure/Certifications Not Applicable. Driving Not Applicable. DUTIES & RESPONSIBILITIES Essential Functions Manage a panel of assigned members to guide along the continuum of care to the optimal functional level and quality of life. Conduct comprehensive assessments and annual or as needed re-assessments of the member’s psychosocial, physical health, functional abilities, and social determinants of health. Develop an individualized care plan based on assessment information that is member-centered, comprehensive and consistent with program guidelines and policies and procedures. Identifies member’s need for LTSS programs, Behavioral Health Services, community supports and other services to fill gaps in care, monitors effectiveness of services. Conducts outreach to member for care plan review, needs assessment and acuity monitoring. Establishes and maintains open and effective communication with physicians and other health care and social service workers. Provides appropriate information on all significant aspects of member’s care and program operations, while maintaining necessary confidentiality. Maintains necessary and complete documentation for all case management activities in the plan’s case management system, MedHOK. Leads and/or participates in clinical huddles and interdisciplinary care team meetings with internal HPSM staff and external partners and providers. Make referrals to various HPSM departments, community-based organizations, and governmental agencies when health and/or psychosocial condition(s) indicate need for appropriate referrals(s). Promotes clear communication amongst the care team, which can include family and community supports, and treating providers by ensuring awareness regarding member care plans, and when supporting care transitions. Teach appropriate interventions, link to resources, educate about benefits, and discuss medication effects and side effects to patient, caregiver, volunteers, and others as appropriate. Adhere to case management practice standards at all times. Participate in continuous quality improvement efforts. Maintain knowledge of HPSM benefits, programs, and processes, in order to provide clear information to member and providers. Maintain knowledge of community resources and programs. Maintain working knowledge of confidentiality practices and standards. Adheres to all standards of confidentiality and patient health information.

Responsibilities

The Clinical Care Manager will manage a panel of assigned members, conducting comprehensive assessments and developing individualized care plans. They will coordinate services with various departments and community partners to ensure optimal care and support for members.