Care Manager (Transitional Care Services)

$72,093 - $115,357/Yr

CalOptima - Orange, CA

Full-time - Mid Level

Remote - Orange, CA

Insurance Carriers and Related Activities

About the position

The Care Manager for Transitional Care Services at CalOptima Health is responsible for facilitating communication and coordination among healthcare team members and members transitioning from hospital care. This role ensures that members receive the necessary support and services to promote quality and cost-effective outcomes during their transition of care. The Care Manager will assess member needs, develop care plans, and coordinate with various providers and community resources to ensure successful transitions of care.

Responsibilities

• Assess member needs using standardized health assessments.
• Perform post-discharge assessments to identify member needs.
• Develop and implement specific care plans with SMART goals.
• Schedule weekly follow-ups with members to assess progress.
• Provide regular outreach to assigned members and evaluate service quality.
• Coordinate care and referrals with members and providers.
• Conduct face-to-face meetings in various settings with members and providers.
• Communicate with physicians and community agencies to ensure service coordination.
• Facilitate referrals to behavioral health and community resources.
• Participate in Interdisciplinary Care Team meetings as needed.
• Prepare and maintain documentation of patient care and progress.
• Advocate for members' best interests regarding funding and treatment alternatives.
• Assist the team in carrying out department responsibilities.

Requirements

• Bachelor's degree in social work, psychology, gerontology, public health or related field.
• 2 years of clinical experience and/or managed care experience.
• Valid driver's license and acceptable driving record.

Nice-to-haves

• Licensed Vocational Nurse or Registered Nurse.
• Master's degree in social work, gerontology, public health or related field.
• Experience with behavioral health or substance use case management.
• Certified Case Manager (CCM) certificate.
• Bilingual in English and one of CalOptima Health's defined threshold languages.

Benefits

• 401(a) retirement plan
• 457(b) retirement plan
• Health insurance
• Dental insurance
• Vision insurance
• Paid time off
• Wellness program