The Outpatient Case Manager/ Careplan Case Manager is responsible for developing careplans of all conditions, diagnoses and positive findings on HRAs, Medical Records, Trigger reports, admission reports and any other pertinent clinical records using HP criteria in SMART goals format. 

Primary focus will be developing individualize care plan and documentation to meet all regulatory requirements, NCQA, CMS, State (APL/DPL) on turned around time.Review and analyze available clinical data, develop a person centered evidence based care plan by identifying member problems, goals, barriers, developing care plans base on SMART goals.

Qualifications

• Graduate from an accredited Registered Nursing Program or Licensed Vocational Nursing Program.
• Current CA RN  license, current CPR certification, valid CA Driver’s license.3 years acute care or case management experience preferred.
• 2-3 years of utilization or HMO experience preferred.
• Typing 40 words per minutes with accuracy preferred.
• Must have valid CA DL and provide proof of vehicle insurance.
• Knowledge of computers, faxes, printers and all other office equipment.
• Knowledgeable in MS Office Programs (i.e., Word, Excel, Outlook, Access and PowerPoint)

About the Hospital

As one of the largest physician-led networks in Southern California, we have thousands of physicians and hundreds of hospitals committed to providing quality healthcare to all of the communities we serve.

Every day, our employees are inspired to make a difference in the lives of others as well as transform their own experiences to achieve a higher sense of fulfillment. Our employees become a part of an extraordinary team of people dedicated to health, wellness, and happiness for themselves and others. There is no greater reward than contributing to a positive work environment where compassion, understanding, care and attention are encouraged and valued.