IEHP

Care Manager, RN – ECM

IEHP

full-time

Posted on:

Location Type: Hybrid

Location: Riverside • California • 🇺🇸 United States

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Salary

💰 $91,250 - $120,910 per year

Job Level

Mid-LevelSenior

About the role

  • Responsible for primarily working with a caseload of Members with medical needs.
  • Responsible for utilizing brief medical interventions as necessary to improve the Member’s ability to manage their own health.
  • Provide formal and informal training and support for Enhanced Care Management team Members on medical conditions, including treatments and evidence-base for treatment.
  • Represents the Enhanced Care Management team as the lead member when necessary.
  • Responsible for assisting Members with care coordination needs, including, but not limited to, the following: Conduct comprehensive, holistic assessment according to the scope of the RN license
  • Assimilate assessment information into an individualized care plan (ICP)
  • Communicate ICP with Member, approved family or caregiver and other Members of the care team
  • Lead inter/transdisciplinary care team meetings to share information, update and inform care plan
  • Coordinate with internal and external health partners to support Members comprehensive care needs
  • Participate and lead care transition plan responsibilities.
  • Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community.
  • Responsible for promoting a collaborative and effective working environment within the Enhanced Care Management team by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as they arise, and collaborating on Member case discussions.
  • Responsible for building and maintaining a positive working relationship with Providers, including, but not limited to, communication via in-person, over the phone, and through digital means such as email and fax.
  • Responsible for engaging 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.
  • Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as by identifying and addressing HEDIS gaps, and by identifying, developing, and testing new practices for improving the outcomes of the Enhanced Care Management team.
  • Assists with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services.
  • Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards.
  • Participates in Health Plan staff meetings, trainings, committee meetings, or other activities as needed or as directed by Leadership Team Members.
  • Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Requirements

  • Three (3) or more years of care management experience in a health care delivery setting required
  • Experience in a Health Care Organization or experience in Managed Care setting preferred
  • Minimum of one (1) year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred
  • Associate’s degree in Nursing from an accredited institution required
  • Bachelor’s degree in Nursing from an accredited institution preferred
  • Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
  • Must have a valid California Driver’s license and valid automobile insurance.
  • Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points
  • Knowledgeable and skilled in evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies
  • 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
  • Bilingual (English/Spanish) preferred.
  • Highly skilled interpersonally, with excellent relationship skills
  • Highly skilled in interpersonal communication, including resolving conflict with co-workers
Benefits
  • Competitive salary
  • State of the art fitness center on-site.
  • Medical Insurance with Dental and Vision.
  • Life, short-term, and long-term disability options
  • Career advancement opportunities and professional development.
  • Wellness programs that promote a healthy work-life balance.
  • Flexible Spending Account – Health Care/Childcare
  • CalPERS retirement 457(b) option with a contribution match
  • Paid life insurance for employees
  • Pet care insurance

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills
care managementclinical experienceevidence-based communicationMotivational Interviewingholistic assessmentindividualized care planquality improvementHEDISchronic medical conditionsself-management philosophies
Soft skills
interpersonal skillsrelationship buildingconflict resolutioncollaborationcommunicationcultural sensitivityethical behaviorteam leadershiptraining and supportengagement
Certifications
Registered Nurse (RN) licenseAssociate’s degree in NursingBachelor’s degree in NursingCalifornia Driver’s licenseautomobile insurance