Care Manager

$72,093 - $115,357/Yr

CalOptima - Orange, CA

Full-time - Mid Level

Remote - Orange, CA

Insurance Carriers and Related Activities

About the position

CalOptima Health is seeking a highly motivated and experienced Care Manager to facilitate communication and coordination among all participants of the health care team and the member. The role focuses on providing intensive case management, which includes assessment, planning, implementation, coordination, monitoring, and evaluation of the member's needs to promote quality and cost-effective outcomes.

Responsibilities

• Assess member needs using standardized health needs assessments or health risk assessments.
• Perform comprehensive, disease-specific clinical assessments of all identified cases at least annually.
• Develop and implement a member-specific care plan with prioritized SMART goals.
• Schedule follow-ups to assess progress towards goals and identify barriers.
• Provide regular outreach to assigned members and evaluate service quality according to department standards.
• Coordinate care and services with members, family members, and other providers.
• Conduct face-to-face meetings in various settings, including hospitals and members' homes.
• Communicate with members' physicians, specialists, and community agencies to ensure service coordination.
• Facilitate referrals to behavioral health and community resources.
• Participate in Interdisciplinary Care Team meetings as applicable.
• Prepare and maintain appropriate documentation of patient care and progress.
• Advocate for necessary funding, treatment alternatives, and coordination of care.

Requirements

• Bachelor's degree in social work, psychology, gerontology, public health, or social science.
• 5 years of clinical experience and/or managed care experience required.
• Valid driver's license and vehicle or approved means of transportation.

Nice-to-haves

• Licensed Vocational Nurse (LVN) or Licensed Marriage and Family Therapist (LMFT).
• 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 (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).

Benefits

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