Case Manager (Case Management Exp, Bilingual in Spanish, CA RN License) Orange, CA at Alignment Healthcare USA, LLC in Orange, California

Job Description:

Who is Alignment Healthcare?

• Socially responsible


• Technologically enabled


• Concierge care


• Transformation


• Servant leadership

We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.

We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.

Seeking Candidates in Orange County, California and surrounding area. 

*****RN California License*****

***THIS IS NOT A REMOTE POSITION***

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

The Case Manager is responsible for health care management and coordination, within the scope of licensure, for members with complex and chronic care needs.  The Case Manager delivers care to members utilizing the nursing process and effectively interacts with members, care givers, and other interdisciplinary team participants. The Case Manager will assist with closing gaps in care and resolving barriers that prevent members from attaining improved health.  

The Case Manager will connect with members telephonically.  

General Duties/Responsibilities:

(May include but are not limited to) 

·       Coordinate care by serving as a resource for the member, their family and their physician.

·       Ensure access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate.

·       Complete comprehensive assessments within their scope of practice that includes assessing the member's current health status, resource utilization, past and present treatment plan and services.

·       Collaborates with the member, the PCP and other members of the care team to implement a plan of care.  

·       Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners and specialists on the development of care management treatment plans.

·       Provide education and self-management support based on the member’s unique learning style.

·       Assists in problem solving with providers, claims or service issues.

·       Works closely with delegated or contracted providers, groups or entities to assure effective and efficient care coordination.

·       Maintains confidentiality of all PHI in compliance with state and federal law and Alignment  Healthcare Policy. 

Supervisory Responsibilities:

·       None. 

Minimum Requirements: 

Minimum Experience:

·       1-3 years clinical experience, 2 or more years of case management experience; or any combination of education and experience, which would provide an equivalent background.

·       Health Plan experience preferred

Education/Licensure:

·       Must have and maintain an active, valid, and unrestricted RN or LVN license in the state for which you are applying

Other:

·       Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs

·       Extensive knowledge of the management of chronic conditions

·       Excellent verbal and written communications skills

·       Team player who builds effective working relationships

·       Ability to work independently

·       Experience using standardized clinical guidelines required

·       Strong organizational skills

·       Ability to operate PC-based software programs including proficiency in Word, Excel and PowerPoint

·       Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.

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