RN, Clinical Care Manager II

Gold Coast Health Plan will not sponsor applicants for work visas.

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work - Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP's focuses on 5 Core Values in the workplace:

* Integrity

* Accountability

* Collaboration

* Trust

* Respect

Disclaimers:

* Flexible work schedule is based on job duties, department, organization, or business need.

* Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The Gold Coast Health Plan (GCHP) RN, Clinical Care Manager II supports the GCHP mission to improve the health of the members through provision of the best possible quality care and services. As defined by the Case Management Society of America (CMSA): Care management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.

The RN, Clinical Care Manager II works closely with other team members and is a role model and resource to colleagues. This position acts as a bridge by facilitating communication between the member, member's family and the providers. The RN, Clinical Care Manager II also provides member advocacy and education to maintain or improve clinical outcomes.

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statements

* Promote the most cost-effective healthcare delivery by coordinating with the medical management team.

* Engage members into care coordination activities to reduce care gaps.

* Evaluate for and work toward elimination of barriers to care.

* Formulation of a member-centric care plan in partnership with the member.

* Facilitate reduction of inappropriate utilization of the ER, urgent care and frequent hospitalizations.

* Facilitate and encourage member use of the Medical Home (PCP).

* Assist the member with their physician prescribed treatment plan to facilitate understanding and promote improved adherence.

* Identify benefit structure and educate member regarding management of available benefits

* Ensure confidentiality of utilization review, quality assurance information, and individual beneficiary identification.

* Assist with data collection for special member determination as required.

* Prepare written reports such as summaries of case management functions and updates of case status, use of covered services, supporting and reporting required metrics and other pertinent performance data, as directed.

* Provide accurate documentation to meet departmental policies, regulatory requirements and audits.

* Attend community meetings concerning health issues or provision of health-related services.

* Adhere to all GCHP Policies and Procedures and meet required performance standards.

* Establish and maintain effective working relationships with community resources and service agencies.

* Relationship management skills, including non-aggressive assertiveness

* Ability to engage easily in abstract thought

* Ability to successfully manage conflict, negotiating "win-win" solutions

* Strong organizational, delegation and task prioritization skills

* Member advocacy focus

* Knowledge of required regulatory timelines to ensure department compliance with State contracts

* Ability to convey empathy and is nonjudgmental of the member

* Ability to stay calm and professional when working with internal and external partners.

* Ability to multi-task, both with and without supervision, with attention to detail

* Works collaboratively with external and internal customers

* Exhibits accountability by maintaining good attendance

* Demonstrated competency in documentation as evidenced by clinical audits exceeding 90% at all times

* Demonstrated ability to develop Care Management Job Aid Manuals

* Independently identifies the need for development or change in department processes to improve department efficiency and efficacy

* Functions as a preceptor to new staff and/or provides cross training to current staff

* Serves as a SME to co-workers

* Assists department lead and manager with other duties as assigned

* Acts as a role model for staff in all areas including attendance and punctuality

* Promotes teamwork by routinely offering assistance to others

* Provides first line back up support to CM III

* Other duties as assigned by manager/director

POSITION QUALIFICATIONS

Competency Statements

* Management Skills - Ability to organize and direct oneself and effectively supervise others.

* Business Acumen - Ability to grasp and understand business concepts and issues.

* Customer Oriented - Ability to take care of the customers' needs while following company procedures.

* Coaching and Development - Ability to provide guidance and feedback to help others strengthen specific knowledge/skill areas.

* Communication, Oral - Ability to communicate effectively with others using the spoken word.

* Team Builder - Ability to convince a group of people to work toward a goal.

* Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

SKILLS & ABILITIES

Education: Bachelor's Degree (four-year college or technical school) is preferred, Field of Study: in a health-related field and managed care experience is desired

Experience: 2 plus years of experience in the health care field. Required.

Care management, discharge planning, or equivalent combination of education and experience.

Managed care experience in a health plan, preferred. Maintain Clinical Care Manager role in good standing for at least 1 year

Computer Skills: Strong background and knowledge of computer systems. Personal computer skills included in the MS Office products.

Certifications & Licenses: Active, valid and unrestricted license, Registered Nurse CCM or other CM certification preferred.

Other Requirements:

Desired: An attitude to excel, a special empathy for working with multiple populations, an investigative personality and a willingness to mentor colleagues.

A working knowledge of Medi-Cal and related policy and regulations.

Required: Ability to evaluate clinical and other health data and to communicate effectively both orally and in writing. Ability to synthesize thoughts and plans succinctly in writing. Ability to balance multiple tasks. Strong organizational skills. Critical thinking skills. Flexibility in role delineation and workload assignments. Team player.