Care Manager, RN - ECM - Rancho Team 2 - Remote

Position Summary/Position

Under the general supervision of the Enhanced Care Management Department Leadership this position is responsible for working effectively with the Enhanced Care Management team (ECM) to provide high quality, effective care management to IEHP members. Care management is broadly defined, and can include outreach and engagement to Members, engaging members in skilled therapeutic interactions to promote health behaviors, other behavioral health interventions within scope, coordination of care, resource linkages, working with other professionals and organizations in the community to ensure quality of care for members, seamless transitions of care, and facilitating the right care and the right time for the member. This position works collaboratively with members of the Enhanced Care Management Team (ECM), Members and families, and other professionals, in addition to working collaboratively with the designated health care organization (HCO) medical team. This position, like all positions within IEHP, is expected to model whole health principles of relationship-based care, as well engage in promoting education and understanding of physical health and healthy behaviors to those within IEHP and in the community.

Major Functions (Duties and Responsibilities)

1. Responsible for primarily working with a caseload of Members with medical needs.
2. Responsible for utilizing brief medical interventions as necessary to improve the Member’s ability to manage their own health.
3. Provide formal and informal training and support for Enhanced Care Management team Members on medical conditions, including treatments and evidence-base for treatment. 
4. Represents the Enhanced Care Management team as the lead member when necessary.
5. Responsible for assisting Members with care coordination needs, including, but not limited to, the following:
    a. Conduct comprehensive, holistic assessment according to the scope of the RN license
    b. Assimilate assessment information into an individualized care plan (ICP)
    c. Communicate ICP with Member, approved family or caregiver and other Members of the care team
    d. Lead inter/transdisciplinary care team meetings to share information, update and inform care plan
    e. Coordinate with internal and external health partners to support Members comprehensive care needs
    f. Participate and lead care transition plan responsibilities.
6. Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community.
7. Responsible for promoting a collaborative and effective working environment within the Enhanced Care Management team by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as they arise, and collaborating on Member case discussions. 
8. Responsible for building and maintaining a positive working relationship with Providers, including, but not limited to, communication via in-person, over the phone, and through digital means such as email and fax.
9. Responsible for engaging with Members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the Member and his or her medical/behavioral team, as well as to increase the Member’s sense of control over their whole health.
10. Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as by identifying and addressing HEDIS gaps, and by identifying, developing, and testing new practices for improving the outcomes of the Enhanced Care Management team.
11. Assists with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services.
12. Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards.
13. Participates in Health Plan staff meetings, trainings, committee meetings, or other activities as needed or as directed by Leadership Team Members.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Experience Qualifications

Three (3) or more years of care management experience in a health care delivery setting required.

Preferred Experience

Experience in a Health Care Organization or experience in Managed Care setting preferred.  Minimum of one (1) year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred.

Education Qualifications

Associate’s degree in Nursing from an accredited institution required.

Preferred Education

Bachelor’s degree in Nursing from an accredited institution preferred.

Professional Certification

Professional Licenses

Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required.

Drivers License Required

Knowledge Requirement

Knowledgeable and skilled in evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies.  Understanding of and sensitivity to multi-cultural community.  Deep understanding and knowledge of self-management philosophies and practices, especially as they relate to chronic medical conditions.  Awareness of the impact of unmitigated bias and judgement on health; commitment to addressing both. 

Skills Requirement

Bilingual (English/Spanish) preferred. Highly skilled interpersonally, with excellent relationship skills. Highly skilled in interpersonal communication, including resolving conflict with co-workers.

Abilities Requirement

Able to sufficiently engage members and providers on the phone, including developing effective relationships that are phone-based.  Must be able to work as a member of a highly autonomous team, executing job duties and making skillful decisions as an independent team.

Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

Minimal physical activity; may include standing and repetitive motion.

Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.

Work Model Location

Physical Requirements