Care Manager, RN - ECM, Hemet (Remote)

Overview:

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

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.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

• CalPERS retirement
• 457(b) option with a contribution match
• Generous paid time off- vacation, holidays, sick
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Paid life insurance for employees with additional options
• Short-term, and long-term disability options
• Pet care insurance
• Flexible Spending Account – Health Care/Childcare
• Wellness programs that promote a healthy work-life balance
• Career advancement opportunities and professional development
• Competitive salary with annual merit increase
• Team bonus opportunities

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:
   1. Conduct comprehensive, holistic assessment according to the scope of the RN license
   2. Assimilate assessment information into an individualized care plan (ICP)
   3. Communicate ICP with Member, approved family or caregiver and other Members of the care team
   4. Lead inter/transdisciplinary care team meetings to share information, update and inform care plan
   5. Coordinate with internal and external health partners to support Members comprehensive care needs
   6. 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.

Education & Experience

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

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

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

Key Qualifications

• Must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points
• 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. Bilingual (English/Spanish) preferred
• 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

Start your journey towards a thriving future with IEHP and apply TODAY!

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