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Form of work
SalaryThe Telephonic Case Manager I (TCM I) is responsible for the care coordination of the assigned high risk and/or high cost members, and/or members who are experiencing an acute episodic medical event. The TCM I provides the assigned members with counseling and education as deemed appropriate within scope of practice. This role collaborates with other healthcare professionals involved in the member’s care to support the delivery of quality patient care and continuity of care.
- Create an individualized care plan (ICP) for each assigned member within 15 days of opening case.
- Maintain a case load of 40-60 members.
- Evaluate and document patient acuity within 3 days of opening case and continuously evaluate patient acuity with every interaction.
- Escalate concerns and/or issues that fall outside scope of practice to department management as they arise.
- Collaborate with other departments and healthcare professionals to support the delivery of quality patient care and continuity of care for assigned members.
- Manage the member’s healthcare conditions and assess their progress telephonically to prevent complications and effectively prioritize healthcare needs.
- Provide informational services to assigned members with focus points of entry into healthcare services (i.e. Primary Care Provider, Immediate Care, Member Services, etc.) in an effort to meet the needs of assigned members.
- Complete documentation in member’s electronic medical record (EMR) within established timeframe and ensure that documentation includes the Problem, Intervention, and Plan. Routinely update the member’s plan of care in accordance with the department, organization and health
- Perform other duties as assigned.
- High School diploma or equivalent. Current California Licensed Vocational Nurse (LVN) or Registered Nurse (RN) License.
- 2 years of nursing experience that involves direct patient care and/or direct interaction with patients.
- Knowledge of medical terminology.
- Ability to effectively utilize computers and computer software.
- Ability to effectively communicate with individuals within all levels of the organization, patients, providers, patient family members and others.
- Detail oriented. Ability to manage time effectively and prioritize tasks to meet established deadlines.
- Bilingual preferred, fluent in Spanish and English. (Written and verbal communication)
- At the discretion of DOHC/FHC management, this position has the potential to be a full or hybrid telecommuting position.
