Job Description

KHS reasonably expects to pay starting compensation for the position of Population Health Management Case Manager RN I in the range of $40.20 - 51.26 hourly.

Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

***5,000 Sign on Bonus***

" On-Site Position"

About the role

Under direction of the Kern Health Systems (KHS) PHM Case Management Supervisor RN this position is responsible for providing complex case management (CCM) to diverse groups of high-risk Medicaid populations. Complex case management within Kern Health Systems (KHS) is defined as the coordination of care and services for members who need help navigating the healthcare system to facilitate the appropriate delivery of the right care and services at the right place and time. These services are provided utilizing available resources across a continuum of care and in collaboration with members, caregivers, medical home providers, and ancillary health care providers. KHS utilizes a Population Health approach to identify diverse groups and to enhance member engagement and coordinate care delivery across populations to improve clinical outcomes.

Incumbents in this position are fully competent in all essential areas of basic and complex case management and are expected to use an advanced level of judgment in the discharge of their duties. Case Managers work independently under general direction. This position involves frequent communication with members, caregivers, medical providers, and KHS staff telephonically, electronically and potentially in-person.

Essential Duties and Responsibilities

• Identify members who are considered high risk for medical care resource utilization by reviewing information from referrals from Health Risk Assessments, physicians. other medical providers, or family and assess needs as appropriate
• Conducts assessments to identify the member’s needs and develops a specific care plan to address objectives, barriers, and goals identified during the assessment.
• Coordinate and manage care across the continuum, involving outpatient care, medical home providers, and ancillary services.
• Provides education and coordination of outpatient care to KHS members selected for Case Management.
• Identifies and refers quality of care, coordination of benefits, and third-party liability issues as appropriate.
• Develops collaborative action plans with clearly identified, achievable objectives, focused on modifiable risk factors.
• Completes and documents initial case management assessments per departmental processes.
• Participate in care management conferences and collaborate with team members and community providers.
• Document all care plan notes in accordance with professional standards in a thorough and timely manner per departmental processes.
• Communicate, consult and collaborate with KHS Medical Director on an as needed basis.
• Serve as a liaison to community providers and KHS Members.
• Provide written and verbal communication with contract providers and KHS staff to promote appropriate and timely coordination of care.
• Perform other related duties and special projects as assigned.

CORE COMPENTENCIES / KNOWLEDGE & SKILL REQUIREMENTS:

• Lead by example to support a positive work environment that values patient advocacy, and active listening
• Represent KHS in a positive manner to all members, caregivers, staff and external stakeholders.
• Demonstrate commitment to continuous improvement.
• Strong knowledge of acute chronic care nursing principles, methods and common treatments.
• Strong knowledge of common human diseases and usual and customary methods of treatments.
• Ability to effectively evaluate medical records to determine appropriateness and necessity of care.
• Demonstrated knowledge of health care delivery systems.
• Very strong interpersonal skills, including the ability to establish and maintain effective working relationships with individual at all levels both inside and outside of KHS.
• Intermediate skills in Word and Excel with basic ability to enter data into and navigate through a database.
• Demonstrated ability to respect and maintain the confidentiality of all sensitive information
• Self-directed, with proven ability to work independently with minimum supervision.

EDUCATION, EXPERIENCE & TRAINING REQUIRED:

• Registered Nurse with an active, current, unrestricted California license
• Minimum of two years (2) full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management required.
• Experience working with patients and caregivers regarding self-care and disease management required.
• Experience working in case management or care coordination is a plus.
• Knowledge of Kern County Community resources for seniors and people with disabilities is a plus.
• Associates Degree in Nursing required; Bachelor’s Degree in Nursing preferred

OTHER REQUIREMENTS:

• Travel Up to 10%
• Bilingual (English/Spanish) Preferred

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