CLINICAL CASE MANAGER

Pediatrics Experience and Knowledge Needed

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Clinical Case Manager. The Clinical Case Manager will perform comprehensive assessments, develop individualized care planning, initiate, and coordinate interdisciplinary case conferences with providers of service, support members in creating and adhering to person-centered care plans.  Additionally, the Clinical Case Manager will be coordinating services with other departments, providers, programs, and community partners, as needed, to provide support.

The essential duties and responsibilities will include the following:

• Manage a panel of assigned members to guide along the continuum of care to the optimal functional level and quality of life.
• Conduct comprehensive assessments and annual or as needed re-assessments of the member’s psychosocial, physical health, functional abilities, and social determinants of health.
• Develop an individualized care plan based on assessment information that is member-centered, comprehensive and consistent with program guidelines and policies and procedures.
• Identifies member’s need for LTSS programs, Behavioral Health Services, community supports and other services to fill gaps in care, monitors effectiveness of services.
• Conducts outreach to member for care plan review, needs assessment and acuity monitoring.
• Establishes and maintains open and effective communication with physicians and other health care and social service workers. Provides appropriate information on all significant aspects of member’s care and program operations, while maintaining necessary confidentiality.
• Maintains necessary and complete documentation for all case management activities in the plan’s case management system, MedHOK.
• Leads and/or participates in clinical huddles and interdisciplinary care team meetings with internal HPSM staff and external partners and providers.
• Make referrals to various HPSM departments, community-based organizations, and governmental agencies when health and/or psychosocial condition(s) indicate need for appropriate referrals(s).
• Promotes clear communication amongst the care team, which can include family and community supports, and treating providers by ensuring awareness regarding member care plans, and when supporting care transitions.
• Teach appropriate interventions, link to resources, educate about benefits, and discuss medication effects and side effects to patient, caregiver, volunteers, and others as appropriate.
• Adhere to case management practice standards at all time.
• Participate in continuous quality improvement efforts.
• Maintain knowledge of HPSM benefit, programs, and processes, in order to provide clear information to member and providers.
• Maintain knowledge of community resources and programs.
• Maintain working knowledge of confidentiality practices and standards. Adheres to all standards of confidentiality and patient health information.
• Other duties as assigned.

Requirements

Education and Experience:

Bachelor or Associates degree. Two (2) years clinical experience. Three (3) years of managed care experience preferably in Care Coordination.  Experience working with the health needs of the population served.

License:

Valid California license as a Registered Nurse or LVN, LCSW, LMFT. PHN preferred. Will consider unlicensed Masters Level Social Worker (MSW/ASW).

Certification:

Certification as Certified Case Manager (CCM) preferred or in the process of completing certification when eligible based on CCM application requirements. If certified as a CCM, maintain CCM certification through continuing competence and education appropriate to case management scope of practice

How to Apply

Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: careers@hpsm.org or via fax: (650) 616-8039. File by: Continuous until filled. The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and encourages minority candidates of all backgrounds to apply.

Submissions without a Cover Letter and Salary Expectations may not be considered.