Case Manager II - CCS (RN), Scotts Valley, Salinas and Merced, CA
Case Manager II - CCS (RN)
Multiple positions available in our Scotts Valley, Salinas and Merced office
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve approximately 350,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here or check out this video.
WHAT YOU'LL BE RESPONSIBLE FOR
Developing and managing an individualized comprehensive plan of care for members referred into the assigned Care Management Program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner. Working with and educating members, families, providers, external agencies and internal departments on the Care Management Program and providing assistance as needed. Participating in Quality Improvement studies, continually evaluating the program’s effectiveness and ability in promoting quality driven, cost effective, achievable goals and outcomes for members.
ABOUT THE TEAM
This is a new team forming in the Care Management Department as we, the Alliance, a Medi-Cal managed care plan, implement the Whole-Child Model (WCM), and incorporate California Children’s Services (CCS) covered services into our plan. CCS is a statewide program for children with special health care needs. The CCS services were previously “carved out” (not a covered benefit of our plan) and were coordinated by the respective counties in our contracted areas. We are working with each county in preparation for our July 1, 2018 implementation date to assume responsibility for payment, authorization and care coordination of primary and specialty services for CCS-eligible children and youth. To learn more about the WCH model, integration of CCS services and other resources, click here.
THE IDEAL CANDIDATE
- Be excited about being a part of something new for the health plan, and acknowledge the challenge and opportunity that this time presents
- Learn from our County partners as we implement this program, with a goal of a seamless transition for the families as we target our July 1st effective date
- Be motivated to serve children with special health care needs and partner with their families while able to maintain professional boundaries in relationships that could be built from the time a member is in the NICU to the time they are 21
- Be flexible in a changing and dynamic environment, and appreciate that each day will be a bit different
- Be comfortable spending time on-site with the County during training and onboarding and then translating the knowledge and information back to us
WHAT YOU'LL NEED TO BE SUCCESSFUL
- Knowledge of:
- Principles and practices of clinical nursing
- Principles and practices of case management
- Care management and coordination
- Evidence based practice guidelines in the development of care plans
- Ability to:
- Demonstrate strong critical thinking and problem solving skills
- Interpret and apply policies and regulation
- Define issues, conduct research, interpret data, and identify and evaluate options
- Evaluate medical records and other health care data
- Organize work and manage complex priorities
- Education and Experience:
- Associate’s degree in Nursing
- Minimum of five (5) years of experience in a patient care setting, including at least one (1) year of case management experience or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying
- A minimum of one (1) year of the required patient care experience must be in an acute or outpatient environment, working with the pediatric population
- Current unrestricted license as a Registered Nurse issued by the State of California
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 11 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- Fresh Fruit Delivery
- EV Charging Stations
- And many more!
For a complete position description and to apply online, please visit our careers website at http://www.ccah-alliance.org/careers.html
Applicants must be currently authorized to work in the United States on a full-time basis.