Lead Care Manager - Santa Clara County - HYBRID

Case Manager Direct Hire Hybrid

We are looking for thoughtful, well rounded individuals looking to positively impact one of the TOP healthcare organizations!!

This is an incredible opportunity to gain phenomenal pay while simultaneously gaining medical training, knowledge, experience, and best of all MAKING A HUGE DIFFERENCE! In addition to a wonderful position there is HUGE opportunity for growth!

Case Manager Overview:

Job Summary:The Lead Care Manager (LCM) is a member facing, community-based care management and outreach role. The LCM will be responsible for providing oversight and coordination of health care management services within the Enhanced Care Management (ECM) program. Additionally, the LCM will conduct outreach to ensure members have information and assistance they need for the ECM program.

Essential Functions:

Care Coordination

• Reviews data and interviews potential members and own families to verify eligibility for enrollment in the ECM and completes referral process when necessary
• Conducts appropriate member assessments telephonically and/or in-person.
• Conduct in-person member meetings on a monthly basis.
• Oversee provision of ECM services, including the completion of member assessments, development of member Care Management Plans (CMP), provide educational and community resources and ensure non-duplication of services.
• Documents evidence of care in the member's EHR record concisely and abides by all deadlines.
• Accompany members and families to office visits to serve as an advocate as needed.
• Reassesses care plans to ensure effectiveness in achieving desired outcomes for members and their family.
• Investigates and directs members' and families' inquiries or complaints to appropriate staff members and follows up to ensure satisfactory resolution.
• Follows established policies and procedures and attends all training.
• Maintains knowledge of community services and resources available to members.
• Facilitates care transitions between providers, partners, and referral sources and specialty care providers.
• Follows established protocol around patients experiencing pain, safety concerns and/or mental health concerns and creates safety plans, if necessary.
• Recognizes signs of abuse and escalates accordingly to appropriate staff members/entities.
• Understands and abides by all departmental and companywide policies and procedures.
• Performs other duties as assigned or required.

Outreach:

• Conduct telephonic or in-person outreach efforts to current or prospective members.
• Follows established policies to outreach, enroll and exclude members.
• Verify eligibility for enrollment in the Enhanced Care Management program (ECM).
• Complete a referral to the ECM program when necessary.
• Partners with healthcare professionals, community and social support services, and other healthcare entities to locate members.
• Answer inbound helpline and respond to member inquiries in a timely and professional manner.
• Continuously improve knowledge of company's products and services to better assist members.
• Utilize/review data sharing sites to collect and share patient health information and ER utilization with relevant care teams to initiate transition of care.
• Review and verify the accuracy of the member information file to ensure the data is up to date and that there are no errors.

Job Types: Full-time

Work Location/Schedule: 70% field based 30% Home M-F. 8-5

Paid training provided.

Benefits:

• 401(k)

• 401(k) matching

• Dental insurance

• Health insurance

• Health savings account

• Life insurance

• Paid time off

• Vision insurance

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