Nurse Case Manager I

To initiate and coordinate a multidisciplinary team approach to case management. Engages the
member/member’s representative in a care plan that assists the member in meeting his/her health
and wellness goals. Collaborates, assesses, plans, facilitates, evaluates, and advocates to meet the
comprehensive medical, behavioral, and psychosocial needs of the member, while promoting
quality and cost-effective outcomes.

• Provides case management services independently for a caseload ranging in complexity
  from basic to complex; acuity levels 1-4; performs field-based case management (acuity
  level 5) with supervision.
• Initiates and coordinates individualized care plan for assigned members, addressing both
  clinical and non-clinical components, and ensuring the care plan is available
  to both the member and primary care provider.
• Resolves member needs by utilizing multidisciplinary team strategies, including Health
  Services Integrated Rounds Meetings.
• Ensures a smooth implementation and continuum of care via effective and frequent
  communication with providers, members, and identified health care designee.
• Communicates clearly and effectively through all mediums of communication with
  members, providers, vendors, community partners, and PHC employees.
• Coordinates referrals and authorizations for services required to improve the
  member’s health status.
• Maintains accurate and timely documentation, records, and case files in the PHC
• Case Management System for members in case management.
• Applies evidence-based interventions based upon member’s agreed upon goals/priorities
• Develops and maintains knowledge of a community based network of alternative
  modes of care; aids member to connect with community-based organizations to support
  and enhance wellness.
• Answers and triages department calls, and distributes department referrals with
  guidance, in accordance with identified department service levels.
• Collaborates and coordinates with other internal departments to identify members
  suitable for case management.
• Actively participates in essential skills training, unit and departmental assigned learning,
  and other departmental activities as assigned.
• Functions collaboratively in a team environment, including acting as a support and
  resource to other staff.
• Coordinates and participates in meetings with PHC providers, as assigned.
• Collaborates with other departments with coordination of care needs through the course of case management services.
• Demonstrates competence in NCQA documentation standards.
• Exhibits high professional standards as outlined in the CA Nurse Practice Act and PHC’s Code of Conduct.
• Performs other duties as assigned by the direct supervisor, including the assumption of new duties.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform.  The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change