Case Manager Specialist RN (Bilingual Spanish) Santa Ana - Pavilion - Population Management - FT
Location: Diamond Bar
Posted on: March 20, 2023
Works collaboratively with an assigned panel of physicians to
manage the patient's specialized needs. The managing team does
differ according to the chronic disease. Duties include assessment
to identify member needs and development of specific care
management plan to address needs. In conjunction with the
Physician, implements care/treatment plan by coordinating access to
health services across multiple providers/ disciplines, monitors
care, makes determination to arrange transportation and transfer
patient if indicated, identifies cost-effective measures, makes
recommendations for alternative levels of care and utilization of
resources, promotes self-care management and ensures paper work is
completed. Is an indirect caregiver. Complies with other duties as
described. Must be able to work collaboratively with the
- Evaluates and identifies members' needs. Interfaces with
Primary Care Physicians, Specialists and various disciplines on the
development of case management plans/programs.
- Monitors and evaluates the effectiveness of the case management
plans and modifies as necessary.
- Coordinates the interdisciplinary approach to providing
continuity of care, including utilization management, transfer
coordination, discharge planning and obtaining all
authorizations/approvals/transfers as needed for outside services
- Acts as a clinical liaison, per their specialty, with outside
agencies such as County CCS, non-plan facilities, outside
providers, employers and/or workers' compensation carriers and
third party administrators.
- Prepares reports, communicates program changes to appropriate
staff and develops protocols in accordance with state
- Acts as a patient advocate and educator to assure that the
patient has the knowledge to care for his/her condition and patient
is educated and empowered to be responsible for participating in
the plan of care.
- Develops individualized patient/family education plan focused
on self-management, delivers patient/family education specific to a
- Develops and updates training and educational materials and
presents to appropriate staff, members and families. Facilitates
patients' return to normal daily activities by teaching and making
appropriate referrals for outside services/continued care.
- Consults with internal and external physicians, health care
providers, discharge planners, and outside agencies regarding
continued care/treatment or hospitalization or referral to support
services or placement.
- May need to facilitate transportation and housing arrangements
for patient. Coordinates transmission of clinical and benefit
treatment to patients, families and outside agencies.
- Participates in data collection and analysis of clinical
outcomes of care and customer satisfaction standards. Participates
in the formulation and implementation/monitoring of action
strategies and outcomes of care or customer service. Ensures that
accurate records are maintained of the care associated with each
- Interprets regulations, health plan benefits, policies, and
procedures for members, physicians, medical office staff, and
contract providers and outside agencies.
- Minimum two (2) years of clinical experience as an RN in an
acute care or ambulatory care setting required.
- Cancer Program: Two (2) years clinical experience in
- For positions in OB/Gyn: (2) years recent (within the past
three (3) years) clinical experience in Maternal Child Health, FCC,
Ob/Gyn or Women's Health in acute care or ambulatory care.
- Demonstrated knowledge of maternal/fetal medicine, including
high risk pregnancies.
- For positions in Neonatal Intensive Care Unit: Two (2) years
clinical experience in a Level III NICU.
- For positions in High Risk Infant Program: Two (2) years
experience in a Regional or Community NICU; one (1) year of which
should be in an HRIF program or as a discharge planner for an NICU
and/or in a community-based Medically Vulnerable Infant
- This experience may have been at a comparable out-of-state
facility. Case management of patients in a High Risk Infant
Program. Ability to manage annual Synagis Clinic for at-risk
population. Previous case management experience preferred (usually
two (2) years chronic disease case management).
- Total Joint Replacement Travel Surgery Program (OC): One (1)
year clinical experience in Orthopedics.
- Home Based Cardiac Rehab Program: One (1) year clinical
experience in Cardiology.
- Bachelor's degree or equivalent experience four (4) years
- For positions in High Risk Infant Program: Bachelor's degree in
nursing or related field required.
License, Certification, Registration
- Current California RN license required.
- AHA BLS.
- Cancer Program: OCN required within one (1) year of hire.
- High Risk Infant Program: Meet requirements to be a CCS paneled
- Regional Genetic Screening Program: BLS is not required.
- Demonstrated ability to utilize/apply the general and
specialized principles, practices, techniques and methods of
utilization review/management, care coordination, transfer
coordination, discharge planning or case management.
- Working knowledge of regulatory requirements and accreditation
standards (TJC, Medicare, Medi-Cal, etc.).
- Demonstrated ability to utilize written and verbal
communication, interpersonal, critical thinking and problem-solving
- Computer literacy skills required.
- Bilingual (English/Spanish) Level II required.
- Cancer Program: Two (2) years experience in Ambulatory
- Total Joint Replacement Travel Surgery Program (OC): One(1)
year experience in Total Joint Replacement.
- Bachelor's degree in nursing or healthcare related field
- For positions in High Risk Infant Program: Masters degree and
- Case Management Certification or certification in the area of
- Must successfully pass or have passed the bilingual test
(within the last 12 months), or be active in the QBS program.
Job Category: Nursing Licensed & Nurse Practitioners
Keywords: Kaiser, Thousand Oaks , Case Manager Specialist RN (Bilingual Spanish) Santa Ana - Pavilion - Population Management - FT, Other , Diamond Bar, California
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