Rn Care Manager

JOB SUMMARY:

Under the general supervision of the Case Management Manager, this position is responsible for working effectively with, and as part of the ECM Provider to provide high quality, effective care management to Enhanced Care Management (ECM) members. Care management is broadly defined, and can include outreach and engagement to members, engaging members in skilled therapeutic interactions to promote health behaviors, other behavioral health interventions within scope, coordination of care, resource linkages, working with other professionals and organizations in the community to ensure quality of care for members, seamless transitions of care, and facilitating the right care and the right time for the member. This position works collaboratively as part of the ECM Care Team, members and families, and other professionals, in addition to working collaboratively with the designated PCP care team.

MAJOR RESPONSIBILITIES:

1. The BH CM supports ECM Members with behavioral health conditions, with particular attention to ECM Members with SMI and/or SUD needs, through brief interventions and behavioral activation strategies.

2. Responsible for primarily working with a minimum caseload of 50 ECM Members with high risk/complex behavioral health needs.

3. Responsible for utilizing brief behavioral health therapeutic interventions as necessary to improve the Member’s ability to manage their own health;

4. Responsible for brief crisis interventions and warm hand-offs to local crisis resources as needed to address behavioral health needs;

5. Engages Members and supports/encourages Member activation towards achievement of health goals via face-to-face or telephone interactions;

6. Provide formal and informal training and support for ECM members on behavioral health conditions, including treatments and evidence-base for treatment.

7. Represents the ECM Provider as the lead member when necessary.

8. Tracks medical and behavioral health outcome measures in the web-based care management platform or equivalent platform;

9. Tracks and assures required assessments and screenings are performed,

10. Provides Member and family education about chronic medical and behavioral health conditions to improve health literacy;

11. Ensures smooth transitions of care from psychiatric facilities;

12. Reviews health assessments (splits role with RNCM) upon completion by other care team members;

13. Collaborates on Member care issues with other ECM Care Team members, participating in weekly systematic case reviews and ad hoc case reviews;

14. Collaborates on Member care issues with other ECM Care Team members, participating in weekly systematic case reviews and ad hoc case reviews;

15. Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community and within the ECM Care Team.

16. Works with Members to identify health/wellness goals, and incorporates these goals into the Member’s Shared Care Plan that facilitate communication among Members and Providers;

17. Responsible for ongoing engagement with Members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the Member and his or her medical/behavioral team, as well as to increase the Member’s sense of control over their whole health;

18. Provides consultation for all members of the team when discussing tasks of a clinical nature.

19. Assists with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services.

20. Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards.

21. Participates in staff meetings, trainings, committee meetings, or other activities as needed or as directed by CHSI and ECM Health Plan.

22. Ensures the privacy and security of PHI (Protected Health Information) as outlined in policies and procedures relating to HIPAA compliance including attending annual compliance training.

23. Any other duties as required to ensure ECM operations are successful.

SUPERVISORY RESPONSIBILITIES:

· Supervises the ECM Community Health Worker and Care Coordinator.

KNOWLEDGE, SKILLS AND ABILITIES:

· Knowledgeable and skilled in evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies.

· Highly skilled in interpersonal communication, including resolving conflict with co-workers.

· Able to sufficiently engage members and providers on the phone, including developing effective relationships that are phone-based.

· Understanding of and sensitivity to multi-cultural community. Deep understanding and knowledge of self-management philosophies and practices, especially as they relate to chronic medical conditions.

· Awareness of the impact of unmitigated bias and judgement on health; commitment to addressing both.

· Must be able to work as a member of a highly autonomous team, executing job duties and making skillful decisions as an independent team.

• Bilingual (English/Spanish) preferred.
• A high standard of professionalism and professional ethics and conduct is expected in speech, manner, attitude and appearance at all times.
• Possess strong interpersonal skills and ability to work well with others.
• Well-developed verbal and written communication skills and the ability to work cooperatively with divergent groups
• Must possess excellent customer service including verbal and written communication.
• Ability to deal effectively with changing situations and stressful environment.

· Ability to perform tasks related to physical activity to complete the responsibilities of the position.

EXPERIENCE AND EDUCATION:

· Masters in Social Work required.

· A valid California driver's license, a reliable car, and valid automobile insurance are also required. IEHP will verify these requirements, as automobile travel within the Inland Empire required.

· Three (3) or more years of care management experience in a behavioral or medical health care delivery setting.

· Experience in a Health Care Organization or experience in Managed Care setting preferred.

· Minimum 1-year intense case management, social work, clinical setting or behavioral health setting preferred.

· American Heart Association BLS certification required