Coordinate care and reassess member's needs. Ensure that members transition to a setting with adequate caregiving and functional support. Conduct face-to-face visits of all members while in the hospital. Position Requirements Include:
Technical knowledge of statutory regulations and medical terminology. Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff. Ability to interact with persons at all levels in the business environment.
Provide a complete continuum of quality care through close communication with members. Support members with condition education, medication reviews and connections to resources. Qualifications Include: 25-50% travel. Current, unrestricted RN license. Access to reliable transportation.
Active unrestricted Resident OR Non-Resident RN license in state of CA. Minimum of 1 year recent health plan case/care management experience. Knowledge of health and/or patient education and behavioral change techniques. Strong computer technical skills.
Supporting the clinical team in the referral and enrollment process. Coordinating with families, stakeholders and providers for processing referrals and enrolling members into the program. Providing information to members and providers regarding the company's services.
Identify and refer for ancillary and supportive covered benefits. Qualifications for this position include: Graduate of an accredited school of Nursing. Three years of oncology nursing experience. Strong communication skills, problem resolution skills and facilitation skills.
Analyze complex or technically difficult medical malpractice claims. Manage the total claim costs while providing high levels of customer service. Communicate claim activity and processing with the client and maintain professional client relationships. Position Requirements Include:
Bachelor's degree Healthcare, Human Services or related field. Must be an independently licensed behavioral health clinician. 1+ year of clinical experience working directly with individuals who meet the Managed Long Term Services and Supports (MLTSS) target population criteria.
Providing Nursing Home residents with information about choices of services and supports in the community. Meeting and collaborating with the consumer, nursing facility discharge planner and other team members. Organizing the consumer's transition to community living.
Providing follow-up and support calls to members and providers as needed and as assigned by Manager/Supervisor. Required Skills: Ability to attend initial training onsite; driver's license required for on-site care management activities.