The Nurse Case Manager functions under the direct supervision of a physician or nurse performing case management duties for the NEMS-MSO.
Identifies members who meet case management criteria.
Establishes and maintains contact with members and providers.
Assess the members' motivation level, ability to self-manage and comprehension of the case management process.
Identifies achievable case management goals using motivational interviewing techniques.
Coordinates health care needs with members, families, and providers.
Coordinates referrals to appropriate services such as primary care, specialty care, ancillary services, behavioral health, substances abuse treatment, and appropriate State and community resources.
Coordinates resources to ensure that necessary services are provided at the most appropriate level of care and at the appropriate time.
Authorizes requests for services using clinical guidelines.
Promotes member activation, adherence to treatment plan, and engagement in the case management program.
Teaches members with multiple chronic diseases to organize, prioritize, and implement suggested self-management strategies.
Develops and updates case management care plans.
Provides guidance to case management coordinators on simple case management activities. .
Monitors outcomes of case management activities including preparing and interpreting appropriate statistical reports.
Works collaboratively with health plan to meet case management requirement.
Follows regulations, agreements or guidlines applicable to healthcare
Updates policies and procedures as needed to meet health legislative requirements.
Performs duties as assigned by supervisor and the President & CEO.
Marginal Job Functions:
Attends internal and external meetings regarding case management.
Valid California Licensed Vocational Nurse License.
Knowledge of managed care helpful .
Good Communication and interpersonal skills
Bilingual in English and Chinese (Cantonese)font >
Knowledge of community resources and cultural needs
Recent experience in case management or care management is helpful
Ability to work with providers, members and their family
Ability to perform efficiently and appropriately in busy environment.
Types a minimum of 35 w.p.m
Strong analytical and problem solving skills
Ability to self-manage in a detail oriented environment
Good organization and prioritization skills
North East Medical Services (NEMS) is a non-profit community health center serving the medically-underserved populations of the San...