Population Health Case Manager RN I

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications.  A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization.  Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

KHS reasonably expects to pay starting compensation for the position of Population Health Management Case Manager RN in the range of $41.08 – $53.27 hourly.
 

Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

RN Bonus - $2,000

PRIMARY PURPOSE:

Under direction of the Kern Health Systems (KHS) PHM Case Management Supervisor RN this position is responsible for providing complex case management (CCM) to diverse groups of high-risk Medicaid populations. Complex case management within Kern Health Systems (KHS) is defined as the coordination of care and services for members who need help navigating the healthcare system to facilitate the appropriate delivery of the right care and services at the right place and time.  These services are provided utilizing available resources across a continuum of care and in collaboration with members, caregivers, medical home providers, and ancillary health care providers. KHS utilizes a Population Health approach to identify diverse groups and to enhance member engagement and coordinate care delivery across populations to improve clinical outcomes.

CLASS CHARACTERISTICS:

Incumbents in this position are fully competent in all essential areas of basic and complex case management and are expected to use an advanced level of judgment in the discharge of their duties.  Case Managers work independently under general direction. This position involves frequent communication with members, caregivers, medical providers, and KHS staff telephonically, electronically and potentially in-person.

SUPERVISES:      None

MAJOR DUTIES & RESPONSIBILITIES:

• Identify members who are considered high risk for medical care resource utilization by reviewing information from referrals from Health Risk Assessments and physicians or family.  Also when referred through ED, Pharmacy, Hospital, and other departmental or systems reporting.
• Conducts assessments to identify the member’s needs and develops a specific care plan to address objectives, barriers, and goals identified during the assessment.
• Monitors and evaluates the effectiveness of the care plan and modifies as necessary.
• Comprehensively identify strengths and opportunities for members, including physical, behavioral and social support system capacities and degree of engagement with providers;
• Provides education and coordination of outpatient care to KHS members selected for Case Management.
• Utilizes Medicaid and other standardized criteria to review DME, home care, rehab and SNF referrals for medical necessity and benefit coverage in assessing and formulating the member’s plan of care.
• Identifies and refers quality of care, coordination of benefits, and third party liability issues as appropriate.
• Develops collaborative action plans with clearly identified, achievable objectives, focused on modifiable risk factors.
• Opens case and attempts to contact member/provider with case management referrals.
• Completes and documents initial case management assessments.
• Recognize members’ right to participate or refuse treatment.
• Participates in and facilitates, as needed, care management conferences for members with complex medical needs.
• Document all care plan notes in accordance with professional standards in a thorough and timely manner.
• Communicate, consult and collaborate with KHS Medical Director on an as needed basis.
• Serve as a liaison to community providers and KHS Members.
• Collaborate with KHS staff to facilitate production of reporting necessary to obtain statistics to monitor, establish and identify member care needs.
• Provide written and verbal communication with contract providers and KHS staff to promote appropriate and timely coordination of care.
• Perform other related duties and special projects as assigned.

REQUIREMENTS:

CORE COMPENTENCIES / KNOWLEDGE & SKILL REQUIREMENTS

• Lead by example to support a positive work environment that values patient advocacy, respectful listening, diverse expression of opinion and constructive conflict resolution;
• Adheres to KHS’s Code of Ethics and Business Conduct and all company policies; e.g., confidentiality, attendance, safety/security, use of equipment and technology, appearance and demeanor;
• Represent KHS in a positive manner to all members, caregivers, staff and external stakeholders; 
• Demonstrate commitment to continuous improvement;
• Strong knowledge of acute chronic care nursing principles, methods and common treatments;
• Strong knowledge of common human diseases and usual and customary methods of treatments;
• Demonstrated knowledge of medical terminology;
• Ability to effectively evaluate medical records to determine appropriateness and necessity of care;
• Demonstrated knowledge of health care delivery systems;
• Thorough understanding of advanced care planning issues and resources including POLST, Advanced Directives, Palliative and Hospice Care.
• Very strong interpersonal skills, including the ability to establish and maintain effective working relationships with individual at all levels both inside and outside of KHS;
• Ability to use tact and diplomacy to diffuse emotional situations;
• Effective oral and written communication skills, including the ability to effectively explain complex information and document according to standards;
• Intermediate skills in Word and Excel with basic ability to enter data into and navigate through a database;
• Demonstrated ability to respect and maintain the confidentiality of all sensitive documents, records, discussions and other information generated in connection with activities conducted in, or related to,  patient healthcare, KHS business or employee information and make no disclosure of such information except as required in the conduct of business;
• Demonstrated ability to commit to and facilitate an atmosphere of collaboration and team work;
• Self-directed, with proven ability to work independently with minimum supervision;
• Demonstrated ability to multi-task in an interrupt-driven environment and complete assignments on a timely basis;
• Strong attention to detail; work accurately and at a reasonable rate of speed;
• Compliant with KHS policies and procedures; performs the job safely and with respect to others, to property, and to individual safety.

EDUCATION, EXPERIENCE & TRAINING REQUIRED:

• Registered Nurse with an active, current, unrestricted California license

• Minimum of two years (2) full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management required;
• Experience working with patients and caregivers regarding self-care and disease management required;
• Experience working in case management or care coordination is a plus;
• Knowledge of Kern County Community resources for seniors and people with disabilities is a plus;
• Bachelor’s Degree from an accredited institution or equivalent in Nursing, Health Administration, or related healthcare field preferred.

OTHER REQUIREMENTS:

• Possession of valid driver’s license and proof of State required auto liability insurance. Required Travel Up to 5%
• Bilingual (English/Spanish) Preferred

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.