ASSOCIATION FOR COMMUNITY AFFILIATED PLANS
RN Case Manager
ASSOCIATION FOR COMMUNITY AFFILIATED PLANS, Washington, District of Columbia, us, 20022
General Description of Position
The RN Case Manager is responsible for providing on‑going case management services for Santa Clara Family Health Plan (SCFHP) members. As a SCFHP member advocate, the RN Case Manager facilitates communication and coordination among all participants of the care team to ensure member identified goals and needed services are provided to promote quality cost‑effective outcomes. Through the development and implementation of member individualized care plans, the RN Case Manager provides medical and psychosocial case management support to help coordinate resources and services for individuals across the healthcare and social services continuum, and facilitates the use of available healthcare benefits in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements.
Requirements – Required (R) Desired (D)
Active California RN License without restriction. (R)
Minimum three years of experience in case management, discharge planning, or education or certifications, or equivalent experience. (R)
Knowledge of managed care principles and practices with emphasis in Utilization Management and/or Case Management. (R)
Clinical knowledge and critical thinking skills with the ability to assess individualized whole‑person care needs necessary to develop an effective care plan. (R)
Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R)
Spanish, Vietnamese, Chinese, or Tagalog language bi‑lingual skills. (D)
Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities, children). (D)
Ability to work within an interdisciplinary team structure. (R)
Ability to conduct home, facility and other community‑based visits. (R)
Maintenance of a valid California driver’s license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)
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Requirements – Required (R) Desired (D)
Active California RN License without restriction. (R)
Minimum three years of experience in case management, discharge planning, or education or certifications, or equivalent experience. (R)
Knowledge of managed care principles and practices with emphasis in Utilization Management and/or Case Management. (R)
Clinical knowledge and critical thinking skills with the ability to assess individualized whole‑person care needs necessary to develop an effective care plan. (R)
Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R)
Spanish, Vietnamese, Chinese, or Tagalog language bi‑lingual skills. (D)
Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities, children). (D)
Ability to work within an interdisciplinary team structure. (R)
Ability to conduct home, facility and other community‑based visits. (R)
Maintenance of a valid California driver’s license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)
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