Utilization Management Case Manager
Company: San Ysidro Health
Location: Chula Vista
Posted on: July 31, 2022
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Job Description:
Position Summary: Under the supervision of the Utilization
Management Manager, the Case Manager is responsible for
constructing a comprehensive care plan and providing a range of
care coordination services; including but not limited to, monthly
health interviews with patients, coordination with family members
and caregivers, and working with community services to ensure
access to care. The Case Manager is comfortable in providing
guidance and completion of needs assessments, development of
patient-focused care plans, periodic reassessments, and
comprehensive service coordination (such as assisting with access
challenges, developing relationships with service providers, and
tracking interventions and outcomes). In addition, the Case Manager
will provide telephonic Care Management (non-face-to-face)
services, as an extension of the clinical staff of SYHealth,
managing patients with 2 or more diagnosed chronic
conditions.Essential Functions of the Job: Develop an
individualized comprehensive plan of care integrating primary care
and community support services to achieve the whole-person health
goals designed with interventions to improve functional status,
health status, or prevent decline. Identify and initiate referrals
for social service programs; including financial, psychosocial,
community and state supportive services integrating community
social supports into the comprehensive care plan to include
mitigating housing instability and homelessness. Provide a complete
continuum of quality care through close communication with members
via in-person or telephone interaction assisting clients in
navigating health, behavioral health, and social services systems,
and transitions of care; identify barriers to goals and support
clients and caregivers through advocacy to ensure client needs and
choices are fully represented and supported by their health care
team. Review individual care plans and make monthly phone calls
and/or in-person visits to CCM and ECM enrolled patients. These may
include: Assess current health status. Medication reconciliation &
compliance assessment, as appropriate. Appointment reminders.
Appropriate patient education regarding the patient's condition
management at home/community. Review orders, labs, consults, and
associated documentation; as indicated by clinical providers.
Encourage and provide resources on preventative health services.
Thorough documentation in the patient's electronic health record
regarding the care plan reflecting outreach, communication, updated
information, test results, social determinants, and any additional
required documentation according to the patient's care plan. Manage
the flow of information to/from provider's office and/or community
resources to the patient and appropriate caregivers. Manage
caseloads according mandated program requirements to ensure
compliance with timely completion of care planning, follow up
activities, documentation and submission timeframes, and all
components of patient engagement. Prepares and submits productivity
reports daily, weekly, and/or monthly by pre-determined deadlines;
as required. Maintains a comprehensive care management structure:
complete electronic care plan, perform care coordination, assist
with transitions of care along with other care management services,
record patient health information, and communicates timely key
patient health information, and provides health promotion and
additional services to help members with community and social
services (such as housing, transportation, and food), as required.
Utilizes the Primary Care Medical Home model to provide coordinated
Team Care that addresses current diseases and facilitates
inter-disciplinary management for preventative and health
maintenance follow-up for patients enrolled in ECM. As required,
meets with the clinic Care Team and other community resources to
identify and implement actions for improving population management
outcomes. Reinforces information given to the patient and/or family
with handouts to improve patient self-management skills and
communication. Acts as a point of contact for patients and families
for asking questions and raising concerns. Serve as an advocate for
patients by creating a bridge between them and community agencies.
Positively impacts patient experience by demonstrating values of
Transforming Care including, but not limited to courteous and
helpful behavior and a commitment to accuracy. Facilitates referral
from SYHealth and community resources for assistance with other
needs and complex issues. Additional Duties and Responsibilities:
Maintains established departmental policies and procedures,
objectives, quality assurance programs, safety, environmental and
infection control standards. Works effectively with people from
diverse cultures and socioeconomic backgrounds. Enhances
professional growth and development through participation in
educational programs, current literature, in-service meetings and
workshops. Attends meeting as required and participates on
committees as directed. Participates in outreach events, as
required. Performs other related duties as assigned or requested.
Job Requirements: Education Required (Minimum level of education):
Bachelor's degree (social work, psychology or a related
health/human services field) or Licensed Vocational Nurse
certification. Certifications/Licenses Required: CA driver's
license and vehicle with appropriate insurance coverage. Local
travel is required for work in the field for this position.
Experience Required (Minimum level of experience): 2 years of
experience in chronic care and/or disease management with minimum
of one year of experience in a healthcare setting, preferably
providing direct patient care, or with duties encompassing patient
education, advocacy, and navigation of connections across complex
health systems and community services. Resourceful community
liaison required with experience in managed care and clinical
quality helpful. Verbal and Written Skills Required to perform the
Job: Good written and verbal communication. Bilingual strongly
preferred. Working Traits: Superb organizational ability and
exceptionally analytical. Willing and able to work in different
environments, including being office based and spending time on the
ground within communities. Technical Knowledge and Skills Required
to Perform the Job: Experience and proficiency with Microsoft
Office software; especially Excel. Experience managing EHR system.
Equipment Used: Personal Computer and/or Laptop Working Conditions
and Physical Requirements: Prolonged periods of sitting, and
constant walking and standing. Driving and travel required. The
employee may be in contact with individuals and families in crisis
who may not be attentive to basic personal hygiene, health, and
safety practices. The employee must be ready to respond quickly and
effectively to many types of situations. About UsSan Ysidro Health
is a Federally Qualified Health Care organization committed to
providing high quality, compassionate, accessible and affordable
healthcare services for the entire family. The organization was
founded by seven women in search ofmedical services for their
families and community. Almost 50 years later, SanYsidro Health now
provides innovative care to over 108,000 patients through avast and
integrated network of 47 program sites across the county. San
YsidroHealth could not serve our patients without the dedication of
our passionateand hardworking employees. Apply today and become a
part of our mission-driven team!San Ysidro Health has a
long-standing commitment to equal employment opportunity for all
applicants for employment. Employment decisions including, but not
limited to, those such as employee selection, performance
evaluation, administration of benefits, working conditions,
employee programs, transfers, position changes, training,
disciplinary action, compensation, and separations are made without
regard to race, color, religion (including religious dress and
grooming), creed, national origin, nationality, citizenship status,
domestic partnership status, ancestry, gender, affectional or
sexual orientation, gender identity or expression, marital status,
civil union status, family status, age, mental or physical
disability (including AIDS or HIV-related status), atypical
heredity cellular or blood trait of an individual, genetic
information or refusal to submit to a genetic test or make
available the results of a genetic test, military status, veteran
status, or any other characteristic protected by applicable
federal, state, or local laws. Other details Pay Type Hourly Apply
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Keywords: San Ysidro Health, Chula Vista , Utilization Management Case Manager, Executive , Chula Vista, California
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