PHM Case Manager RN I

Work Location: Onsite or Hybrid


About us

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

About the role

Under direction of the Kern Family Health Care (KFHC) 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 Family Health Care (KFHC) 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. KFHC 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 KFHC staff telephonically, electronically and potentially in-person.

Essential Functions


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 KFHC 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 KFHC Medical Director on an as needed basis.
Serve as a liaison to community providers and KFHC Members.
Provide written and verbal communication with contract providers and KFHC staff to promote appropriate and timely coordination of care.
Perform other related duties and special projects as assigned.


Employment Standards:


Registered Nurse with an active, current, unrestricted California license
Associates Degree in Nursing required; Bachelor’s Degree in Nursing preferred


2 years of 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.


OTHER REQUIREMENTS:


Travel Up to 10%


Bilingual (English/Spanish) Preferred

Pay range shown reflects the full range for this position. Initial offers are typically positioned between the minimum and midpoint, based on qualifications and internal equity.

Pay Range: Minimum: $40.20 Mid-Point: $51.26 Maximum: $62.31