Community Based Adult Services (CBAS) RN - 912 - Rancho Cucamonga

Job Description

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan (with more than 1.26 million members) in the Inland Empire. We are also one of the largest employers in the region. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and MAKE A Difference with us!IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

POSITION PURPOSE:

Under the general direction of the TOC Manager, the CBAS RN is responsible for working directly with Independent Practice Associations (IPAs), medical groups, Providers, community agencies, Members/caregivers, and other entities supporting Member care to ensure coordinated, continuous care and serve as a resource person for these facilities.

MAJOR RESPONSIBILITIES:

  • Conduct face-to-face nursing assessments for potential CBAS Members utilizing the CBAS Eligibility Determination Tool (CEDT).
  • Ensure the health plan has a copy of the CBAS Individual Plan of Care (IPC) in the medical management system (mms).
  • Conduct Member Outreach calls to educate potential Members regarding CBAS services.
  • Facilitate referrals to appropriate CBAS Centers.
  • Schedule face-to-face assessments, complete CEDT, and submit to the Medical Director for review and approval. 
  • Act as a Member Advocate.
  • Maintain positive working relationship with CBAS center staff.Assist with coordination of care as needed. 
  • Work collaboratively with Care Management to ensure Members/caregivers are meeting IPC goals.Assist Members with immediate needs with regard to access, referrals and authorizations.
  • Assist Member with resources such as Long-Term Support Services (LTSS), Disabilities, Behavioral Health, and other community resources.
  • Comply with IEHP Policies with traveling to and from CBAS Centers.Ensure the privacy and security of Protected Health Information (PHI), as outlined in IEHP's policies and procedures relating to HIPAA compliance.
  • Responsible for any other duties as required to ensure successful care management processes, Member outcomes, and Health Plan operations.

Qualifications

MINIMUM QUALIFICATIONS:

Possession of a valid RN or issued by the State of California. Possession of a valid State of California driver’s license and active automobile insurance coverage.

Three (3) or more years of care management experience in a health care delivery setting. Experience in an HMO or experience in Managed Care setting preferred. Minimum one year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred.