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Location: Telecommuting

Case Manager, Sr – TELECOMMUTING OPTION (Woodland Hills, CA) CA RN License Required

Description

[Company, NYSE Symb.] is among the nation’s largest publicly traded managed health care companies.  [Company's]  mission is to help people be healthy, secure and comfortable.  The company’s POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals.  For more information on Health Net, Inc., please visit the company’s Web Site at [See URL below]

JOB SUMMARY:  CASE MANAGER, SR – Integrated Telecommuting Option

The Senior Case Manager/Care Coordinator is responsible for the coordination of services and cost effective management of health care resources to meet individual members’ health care needs and promote positive health outcomes.   Acts as a member advocate and a liaison between providers, members and Health Net to seamlessly integrate complex services.  Case Management services are generally focused on members who fall into one or more high risk or high cost groups and require significant clinical judgement, independent analysis, critical-thinking, detailed knowledge of departmental procedures, clinical guidelines, community resources, contracting and community standards of care. Case Management includes assessment, coordination, planning, monitoring and evaluation of multiple environments.  Acts as a resource for training, policy and regulatory/ accreditation interpretation.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

* Manages individual member cases by coordinating the provisions of services, assuring the cost-effective utilization of health care resources to meet individual members’ health care needs and promote positive health outcomes.
* Significant clinical judgement, independent analysis, critical-thinking, detailed knowledge of departmental procedures, clinical guidelines, community resources, contracting and community standards of care are applied during case management activities.
* The Senior Case Manager/Care Coordinator acts as a member advocate and a liaison between providers, member and Health Net to seamlessly integrate complex services.

Qualifications

REQUIREMENTS:

Education:

Graduate of an accredited nursing program required; Bachelor’s degree preferred for nursing graduates.

Certification/License:

* Active, valid & unrestricted state of California Registered Nurse license required.
* Case Management certification preferred.

Experience:

* Minimum three years clinical experience required.
* Three to five years Case Management experience required.
* Health Plan experience preferred.

Knowledge, Skills & Abilities:

* Bilingual English/Other desired.
* Strong knowledge of NCQA, federal and state regulations/requirements.
* Demonstrated ability for assessment, evaluation and interpretation of medical information, and care planning.
* 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.
* Strong analytical and problem solving skills.
* Excellent verbal and written communications skills.
* Excellent case preparation and abstracting skills.
* Team player who builds effective working relationships.
* Ability to work independently.
* Experience using standardized clinical guidelines required.
* Must be able to work well with all levels in the organization.
* Able to operate PC-based software programs including proficiency in Word, Excel, PowerPoint, Access and Project.
* Ability to effectively analyze, interpret, apply and communicate policies, procedures and regulations.

OR

Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

[Company] supports a drug-free work environment and requires pre-employment background and drug screening.

Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.
Job -Care / Case Management
Primary Location -California-Woodland Hills
Organization – [See URL below]
Schedule -Full-time
Job Type -Regular
Shift -Day Job
Travel -Yes, 10% of the time
Overtime Status -Exempt

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