CARE MANAGER
Stanford Health Care
Care Manager, RN
IEHP
full-time
Posted on:
Origin: • 🇺🇸 United States • California
Visit company websiteSalary
💰 $91,250 - $120,910 per year
Job Level
JuniorMid-Level
About the role
- Reporting to Health Services department leadership, this position is responsible for working effectively to provide high quality, effective care management to IEHP 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 with members of the Integrated Care Team, members and families, and other professionals, in addition to working collaboratively with the designated health care organization’s (HCO) medical team.
- Model whole health principles of relationship-based care, as well engage in promoting education and understanding of physical health and healthy behaviors to those within IEHP and in the community.
- Exercise independent clinical judgment and strategic planning in managing a caseload of members with complex medical and behavioral health needs according to department processes and duties.
- Recommend care coordination strategies for members, including but not limited to applying brief medical/behavioral interventions and evidence-based methodologies as necessary to enhance the member’s ability to manage their own health.
- Lead the development of individualized care plans (ICPs) or discharge plans through comprehensive biopsychosocial assessments and interdisciplinary collaboration.
- Facilitate and guide interdisciplinary care team meetings, influencing care plan modifications and alignment with member goals.
- Initiate and oversee quality improvement initiatives and projects that address clinical gaps (e.g., HEDIS measures), improve health outcomes, and support innovation.
- Advocate for timely, high-quality care for members by coordinating with internal partners and external providers across the continuum of services.
- Utilize clinical tools and metrics (e.g., PHQ scores, ER visit trends, hospitalization trends, substance use trends) to inform interventions, manage caseloads, and escalate high-risk cases appropriately.
- Design transitional care strategies for members shifting between care settings, ensuring coordination of services such as home health, DME, and primary care follow-up.
- Implement targeted outreach approaches to support care continuity, promote resource linkage, and empower member self-efficacy across care transitions.
- Cultivate and sustain productive partnerships with providers, team members, and community stakeholders.
- Ensure clinical documentation adheres to all applicable state, federal, and accreditation standards.
- Serve as a subject matter resource by providing formal and informal education to peers and cross-functional staff on medical conditions, treatment protocols, and emerging evidence in behavioral/medical health care.
- Participate in staff meetings, trainings, cross-functional committees, department planning initiatives, and professional conferences to represent Medical and Behavioral Health perspectives and contribute to strategic alignment with organizational goals.
- Perform any other duties as required to ensure Health Plan operations and department business needs are successful.
- Work Location is dependent on department leadership and business need.
Requirements
- Minimum two (2) years clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting required
- Two (2) or more years of care management experience in a health care delivery setting preferred
- Experience in a Managed Care (HMO, IPA) or in acute facility (i.e. hospital) care management 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
- 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
- Must have knowledge of whole health and integrated principles and practices
- Bilingual (English/Spanish) preferred
- Highly skilled in interpersonal communication, including conflict resolution
- Effective written and oral communication skills, as well as reasoning and problem-solving skills
- Proficient in the use of computer software including, but not limited to, Microsoft Word, Excel, PowerPoint
- Demonstrated proficiency with all electronic medical management systems (e.g., Cisco, MHK/Care Prominence, MediTrac, SuperSearch and Web Portal) is preferred
- Proven ability to: Sufficiently engage members and providers on the phone as well as in person
- Work as a member of a team, executing job duties and making skillful decisions within one’s scope
- Establish and maintain a constructive relationship with diverse members, leadership, Team Members, external partners, and vendors
- Prioritize multiple tasks as well as identify and resolve problems
- Have effective time management and the ability to work in a fast-paced environment
- Be extremely organized with attention to detail and accuracy of work product
- Have timely turnaround of assignments expected
- To form cross-functional and interdepartmental relationships
