You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking an experienced Telephonic Case Manager to provide comprehensive telephonic case management to medically complex and chronically ill members. This role involves conducting health assessments, creating individualized care plans, coordinating care, and educating members on various health conditions and medications.

Responsibilities / Job Duties

• Provide telephonic case management to medically complex and chronically ill members (C-SNP population).
• Conduct comprehensive health assessments and create individualized care plans.
• Coordinate care with internal and external partners.
• Conduct ICT/IDT meetings, presenting members to nurse practitioners/RMOs and social workers.
• Provide clinical/disease state education (e.g., CHF, A1C, medications, labs).
• Identify gaps in care and resolve service/access issues.
• Spend 3–4 hours/day on the phone making approximately 30–40 calls (80% outbound from queue/task list and 20% inbound).
• Document directly in the AVA care plan system.
• Delegate non-clinical coordination (appointments, transportation, referrals) to assigned Care Coordinators.

Minimum Education and Experience Qualification Requirements

Qualifications

• Active and current California RN License.
• Fully bilingual/fluent in Spanish and English.
• Previous health plan or IPA experience (highly preferred).
• Bachelor's Degree in Nursing (BSN) (preferred).
• Familiarity with Medicare Advantage / Medicaid versus Medicare (preferred).

Experience

• Minimum 1 year of Case Management experience.

Skills

• Strong verbal communication skills.
• Self-motivated.
• Proficiency in computer usage and good typing skills for documentation.
• Ability to educate members on disease states, blood work, medications, and labs.

Additional Requirements

• Must have a HIPAA compliant workspace.
• Ability to work fully remote, but adhering to Pacific Time hours.

Schedule / Shift

Monday - Friday, 8:00 AM - 5:00 PM PST. One hour lunch break and two 15-minute breaks. Expected 40 hours per week. This is a fully remote position.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

Medix is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

^*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.