Job Description

Description Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. Who Are We? Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. Why Join Us? We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. Job Summary The role of the Case Manager is to promote quality, cost-effective outcomes for an assigned population by facilitating collaboration and coordination across settings, assessing member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member's receive services and resources required to meet desired health and social outcomes. The Case Manager ensures members progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. The Case Manager is responsible for providing patient centered care across the care continuum. Functions & Job Responsibilities Assessment of the medical, social, and behavioral needs of an assigned population Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment. ~ Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals. Conducts telephonic, and face-to-face/virtual visits as required. Performs ongoing monitoring of the care plan to evaluate effectiveness of interventions for goal achievement, suggest changes as needed and document updates accordingly. Maintains ongoing member caseload for regular outreach and management. Promotes integration of services for members including behavioral health care and longterm services and supports/home and community to enhance the continuity of care for Clever Care members. ~ Uses motivational interviewing and Clever Care clinical guidelines to educate, support and motivate change during member contacts. ~ Assesses barriers to care, provides care coordination, and assistance to members to address concerns. ~ Additional duties, as assigned. Qualifications Qualifications Education And Experience Licensures and Certifications ~ Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) or Licesnsed Vocational Nurse (LVN) license issued by the California BRN required. Certified Case Manager (CCM) preferred Certified Managed Care Nurse (CMCN) preferred Skills ~ 2-3 years in case management, disease management, managed care, or medical or behavioral health settings High level of critical thinking and problem-solving skills Strong work ethic and overall positive attitude Effective communication skills including verbal and written Ability to manage time effectively, understand directions, and work independently in a fast-paced environment Demonstrated flexibility, organization, and self-motivation Highly adaptable to change Bilingual in Mandarin/Cantonese, Vietnamese, or Korean, preferred Wage Range: $80,000/year - $95,000/year Physical & Working Environment. Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation: Must be able to travel when needed or required Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking) ~ Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs. Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly. Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business. Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.

Job Tags

Work at office, Remote work,

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