Medical Case Manager (Long-Term Care) CalOptima CalOptima Health is seeking a highly motivated an experienced Medical Case Manager (Long-Term Care) to join our team. The Medical Case Manager for Long Term Care (LTC) is responsible for reviewing and processing requests for authorization and notification of LTC Skilled Nursing Facilities. The incumbent will be responsible for inpatient review and referral related processes which include on-line responsibilities as well as selected off-line tasks. The incumbent utilizes CalOptima Health's medical criteria, policies and procedures to authorize referral requests from medical professionals, clinical facilities and ancillary providers. The incumbent directly interacts with provider callers and serves as a resource for their needs. The incumbent will be part of an advanced specialty collaborative practice, responsible for case management, care coordination, authorization, utilization management and discharge planning of LTC members residing in Skilled Nursing Facilities under custodial care, including members living in the Intermediate Care Facilities under Regional Center guidelines. Position Information: Department: Long Term Care Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 95% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Reviews requests for medical appropriateness for inpatient services utilizing medical criteria and/or established policies and procedures. Performs and/or reviews clinical assessments by using CalOptima Health and California Department of Health Care Services (DHCS) approved standardized tools such as Pre-Admission Screening and Resident Review (PASRR), Minimum Data Set (MDS), Individual Plans of Care, etc. Verifies and processes specialty referrals, Hospice General Inpatient, durable medical equipment and supplies via telephone or fax by using established clinical protocols to determine medical necessity. Screens inpatient requests for Medical Director review, gathers pertinent medical information prior to submission to the Medical Director; follows up with the requester by communicating the Medical Director's decision; documents follow-up in the utilization management system. Completes all documentation accurately and appropriately for data entry into the utilization management or care management system, at the time of the telephone call or fax, to include any authorization updates. Reviews and evaluates proposed services utilizing medical criteria, established policies and procedures, Title 22, Medicare and/or Medi-Cal guidelines. This includes review of submitted medical documentation. Determines the appropriate action regarding the service being requested for approval, modification or denial, and refers to the Medical Director for review when necessary. Initiates contact with patient, family, skilled nursing facility and treating physicians as needed to obtain additional information. Analyzes all requests with the objective of monitoring utilization of services, which includes reviewing for medical appropriateness and identifying potentially high cost complex cases requiring high-level case management intervention. Applies utilization management, authorizations, case management/nursing processes that include assessment, care planning collaboration, advocacy, implementation/intervention, monitoring and evaluation of a member's status. Reports cost analysis, quality of care and/or quality of life improvements as measured against the case management goals. Establishes means of communication and collaboration with CalAIM providers, other team members, physicians, Community Based Adult Services (CBAS) centers, In-Home Support Services (IHSS) liaisons, community agencies, health networks, skilled nursing facilities and administrators. Acts as an advocate in the member's best interest for necessary funding, treatment alternatives, timelines, coordination of care and frequent evaluations of progress and goals. Works collaboratively with staff members from various disciplines involved in patient care with an emphasis on interpreting and problem-solving complex cases. Meets productivity and quality of work standards on an ongoing basis. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Associate degree in nursing (ADN) required PLUS 3 years of clinical experience with the health needs of the population served required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Bachelor of Science in Nursing (BSN) preferred. 3 years of experience in Title 22, Medi-Cal and/or Medicare programs. 1 year of authorization review (in-patient skilled nursing facility) experience. Active Commission for Case Manager (CCM) certification. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Current, unrestricted Registered Nurse (RN) license to practice in the state of California required. Valid driver's license and vehicle, or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office approximately 50% of the time. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 6, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/medical-case-manager-long-term-care-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-722c046327063d4388a2d48500cb0777
Aug 25, 2024
Full Time
Medical Case Manager (Long-Term Care) CalOptima CalOptima Health is seeking a highly motivated an experienced Medical Case Manager (Long-Term Care) to join our team. The Medical Case Manager for Long Term Care (LTC) is responsible for reviewing and processing requests for authorization and notification of LTC Skilled Nursing Facilities. The incumbent will be responsible for inpatient review and referral related processes which include on-line responsibilities as well as selected off-line tasks. The incumbent utilizes CalOptima Health's medical criteria, policies and procedures to authorize referral requests from medical professionals, clinical facilities and ancillary providers. The incumbent directly interacts with provider callers and serves as a resource for their needs. The incumbent will be part of an advanced specialty collaborative practice, responsible for case management, care coordination, authorization, utilization management and discharge planning of LTC members residing in Skilled Nursing Facilities under custodial care, including members living in the Intermediate Care Facilities under Regional Center guidelines. Position Information: Department: Long Term Care Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 95% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Reviews requests for medical appropriateness for inpatient services utilizing medical criteria and/or established policies and procedures. Performs and/or reviews clinical assessments by using CalOptima Health and California Department of Health Care Services (DHCS) approved standardized tools such as Pre-Admission Screening and Resident Review (PASRR), Minimum Data Set (MDS), Individual Plans of Care, etc. Verifies and processes specialty referrals, Hospice General Inpatient, durable medical equipment and supplies via telephone or fax by using established clinical protocols to determine medical necessity. Screens inpatient requests for Medical Director review, gathers pertinent medical information prior to submission to the Medical Director; follows up with the requester by communicating the Medical Director's decision; documents follow-up in the utilization management system. Completes all documentation accurately and appropriately for data entry into the utilization management or care management system, at the time of the telephone call or fax, to include any authorization updates. Reviews and evaluates proposed services utilizing medical criteria, established policies and procedures, Title 22, Medicare and/or Medi-Cal guidelines. This includes review of submitted medical documentation. Determines the appropriate action regarding the service being requested for approval, modification or denial, and refers to the Medical Director for review when necessary. Initiates contact with patient, family, skilled nursing facility and treating physicians as needed to obtain additional information. Analyzes all requests with the objective of monitoring utilization of services, which includes reviewing for medical appropriateness and identifying potentially high cost complex cases requiring high-level case management intervention. Applies utilization management, authorizations, case management/nursing processes that include assessment, care planning collaboration, advocacy, implementation/intervention, monitoring and evaluation of a member's status. Reports cost analysis, quality of care and/or quality of life improvements as measured against the case management goals. Establishes means of communication and collaboration with CalAIM providers, other team members, physicians, Community Based Adult Services (CBAS) centers, In-Home Support Services (IHSS) liaisons, community agencies, health networks, skilled nursing facilities and administrators. Acts as an advocate in the member's best interest for necessary funding, treatment alternatives, timelines, coordination of care and frequent evaluations of progress and goals. Works collaboratively with staff members from various disciplines involved in patient care with an emphasis on interpreting and problem-solving complex cases. Meets productivity and quality of work standards on an ongoing basis. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Associate degree in nursing (ADN) required PLUS 3 years of clinical experience with the health needs of the population served required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Bachelor of Science in Nursing (BSN) preferred. 3 years of experience in Title 22, Medi-Cal and/or Medicare programs. 1 year of authorization review (in-patient skilled nursing facility) experience. Active Commission for Case Manager (CCM) certification. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Current, unrestricted Registered Nurse (RN) license to practice in the state of California required. Valid driver's license and vehicle, or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office approximately 50% of the time. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 6, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/medical-case-manager-long-term-care-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-722c046327063d4388a2d48500cb0777
Medical Case Manager-LTSS Emergency Department Program CalOptima CalOptima Health is seeking a highly motivated an experienced Medical Case Manager-LTSS Emergency Department Program to join our team. The Medical Case Manager for Long Term Services Supports (LTSS) Emergency Department Program is part of an advanced specialty collaborative practice, responsible for case management, care coordination, authorization and utilization management of the assigned population of focus (emergency department, Community Adult Based Services (CBAS), CalAIM, complex discharge and long-term care (LTC) members residing in nursing facilities under custodial care) including members in OneCare programs, Medi-Cal only members or members living in the intermediate care facilities under regional center guidelines. The incumbent will be embedded in the assigned emergency department 80-90% of the time. The incumbent will perform utilization functions and authorizations, provide coordination of care and ongoing case management services for CalOptima Health members discharging from emergency departments and LTC facilities. The incumbent will serve as the subject matter expert and act as a liaison to Orange County based community agencies, emergency departments, CalAIM program and providers, CBAS centers, Multi-purpose Senior Service Program (MSSP), In-Home Support Services (IHSS) liaisons, skilled nursing facilities, members and providers. Position Information: Department: Long Term Care Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615) Work Arrangement: Community Worker Duties & Responsibilities: 85% - Care Management & Medical Review Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Applies utilization management, authorizations and case management/nursing processes that include assessment, care planning collaboration, advocacy, implementation/intervention, monitoring and evaluation of a member's status. Performs and/or reviews clinical assessments by using CalAIM, CalOptima Health and the California Department of Health Care Services (DHCS) approved standardized tools such as Pre-Admission Screening and Resident Review (PASRR), Minimum Data Set (MDS), CBAS Eligibility Determination Tool (CEDT), health risk assessment (HRA), individual plans of care, etc. Participates in hospital and emergency department rounds. Collaborates with hospitals and emergency departments on complex discharges. Participates in discharge planning for CalOptima Health members that may be discharged to the community or from hospitals to nursing facilities; discharge planning may include services for CalAIM, transportation, pharmacy, primary care physician (PCP) appointments, community resources, social determinants of health (SDoH) assessments, LTC, MSSP and CBAS. Communicates timely with CalAIM providers and members to coordinate and initiate Community Support (CS) services and Enhanced Care Management (ECM). Completes all documentation accurately and appropriately for data entry into the utilization management or care management system at the time of the telephone call or fax to include any authorization updates. Reviews and evaluates proposed services utilizing medical criteria, established policies and procedures, Title 22, Medicare and/or Medi-Cal guidelines; this includes review of submitted medical documentation. Determines the appropriate action regarding the service being requested for approval, modification or denial and refers to the Medical Director for review when necessary. Initiates contact with patient, family and treating physicians as needed to obtain additional information or to introduce the role of CalAIM and case management. Analyzes all requests with the objective of monitoring utilization of services, which includes medical appropriateness and identify potentially high cost, complex cases for high level case management intervention. For short-term cases, conducts a thorough and objective assessment of the member's current physical, psychosocial and environmental status and gathers all information pertinent to the case. Develops, implements and monitors a care plan through the interdisciplinary team process in conjunction with the individual member and family in internal and external settings across the continuum of care. Assesses member's status and progress routinely; if progress is static or regressive, determines reason and proactively encourages appropriate referrals to a higher level of case management or makes appropriate adjustments in the care plan, providers and/or services to promote better outcomes. Reports cost analysis, quality of care and/or quality of life improvements as measured against the case management goals. Establishes means of communication and collaboration with CalAIM providers, other team members, physicians, CBAS centers, IHSS liaisons, community agencies, health networks, skilled nursing facilities and administrators. Prepares and maintains appropriate documentation of patient care and progress within the care plan. Acts as an advocate in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals. Works collaboratively with staff members from various disciplines involved in patient care with an emphasis on interpreting and problem-solving complex cases. Documents case notes and rationale for all decisions and care coordination in the Medical Management System (i.e., JIVA, etc.). Conducts assessments by collecting in-depth information about a member's situation, identifies high-risk needs, issues and resources and gathers all information pertinent to the case to write referrals for any gaps in services. Plans and determines specific objectives, goals and actions as identified through the assessment process and makes recommendations to nursing facilities for the care of the patients. Implements goals by conducting specific interventions, including referring members to outside resources and/or community agencies that will result in meeting the goals established in the care plan. Supports implementation of the care plan through an interdisciplinary team process in conjunction with the member, family and all participants of the health care team. Monitors established measurable goals and routinely assesses the member's status and progress to proactively make appropriate recommendations for adjustments in the care plan, providers and/or services to promote better outcomes. Performs utilization review of services requested for members in case management by reviewing all pertinent medical records for medical necessity, applying medical review protocols and criteria and meeting the timeframes per the Utilization Management policies and procedures. 10% - Administrative Support Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Retrieves and monitors incoming inquiries from various sources (i.e., Zeomega Jiva care management system, email, etc.) Participates in training of internal staff and works collaboratively with other CalOptima Health departments to meet member's needs. Serves as a subject matter expert and acts as a liaison between the LTSS department and other CalOptima Health departments to assist with issues, concerns and inquiries. Ensures confidentiality of all protected health information (PHI). Maintains confidentiality of the member's medical information. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Associate degree in nursing (ADN) required. 3 years of clinical experience with the health needs of the population served required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. A valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office approximately 95% of the time. Preferred Qualifications: Bachelor's degree in nursing (BSN). 2 years of experience in LTC, community health (hospital), managed care Medi-Cal, Medicare programs or case management. Active Commission for Case Manager (CCM) certification. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Current, unrestricted Registered Nurse (RN) license to practice in the state of California required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is August 8, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/medical-case-manager-ltss-emergency-department-program-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-952e7c44de954f459ff1a1bcdaa77bcd
Aug 30, 2024
Full Time
Medical Case Manager-LTSS Emergency Department Program CalOptima CalOptima Health is seeking a highly motivated an experienced Medical Case Manager-LTSS Emergency Department Program to join our team. The Medical Case Manager for Long Term Services Supports (LTSS) Emergency Department Program is part of an advanced specialty collaborative practice, responsible for case management, care coordination, authorization and utilization management of the assigned population of focus (emergency department, Community Adult Based Services (CBAS), CalAIM, complex discharge and long-term care (LTC) members residing in nursing facilities under custodial care) including members in OneCare programs, Medi-Cal only members or members living in the intermediate care facilities under regional center guidelines. The incumbent will be embedded in the assigned emergency department 80-90% of the time. The incumbent will perform utilization functions and authorizations, provide coordination of care and ongoing case management services for CalOptima Health members discharging from emergency departments and LTC facilities. The incumbent will serve as the subject matter expert and act as a liaison to Orange County based community agencies, emergency departments, CalAIM program and providers, CBAS centers, Multi-purpose Senior Service Program (MSSP), In-Home Support Services (IHSS) liaisons, skilled nursing facilities, members and providers. Position Information: Department: Long Term Care Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615) Work Arrangement: Community Worker Duties & Responsibilities: 85% - Care Management & Medical Review Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Applies utilization management, authorizations and case management/nursing processes that include assessment, care planning collaboration, advocacy, implementation/intervention, monitoring and evaluation of a member's status. Performs and/or reviews clinical assessments by using CalAIM, CalOptima Health and the California Department of Health Care Services (DHCS) approved standardized tools such as Pre-Admission Screening and Resident Review (PASRR), Minimum Data Set (MDS), CBAS Eligibility Determination Tool (CEDT), health risk assessment (HRA), individual plans of care, etc. Participates in hospital and emergency department rounds. Collaborates with hospitals and emergency departments on complex discharges. Participates in discharge planning for CalOptima Health members that may be discharged to the community or from hospitals to nursing facilities; discharge planning may include services for CalAIM, transportation, pharmacy, primary care physician (PCP) appointments, community resources, social determinants of health (SDoH) assessments, LTC, MSSP and CBAS. Communicates timely with CalAIM providers and members to coordinate and initiate Community Support (CS) services and Enhanced Care Management (ECM). Completes all documentation accurately and appropriately for data entry into the utilization management or care management system at the time of the telephone call or fax to include any authorization updates. Reviews and evaluates proposed services utilizing medical criteria, established policies and procedures, Title 22, Medicare and/or Medi-Cal guidelines; this includes review of submitted medical documentation. Determines the appropriate action regarding the service being requested for approval, modification or denial and refers to the Medical Director for review when necessary. Initiates contact with patient, family and treating physicians as needed to obtain additional information or to introduce the role of CalAIM and case management. Analyzes all requests with the objective of monitoring utilization of services, which includes medical appropriateness and identify potentially high cost, complex cases for high level case management intervention. For short-term cases, conducts a thorough and objective assessment of the member's current physical, psychosocial and environmental status and gathers all information pertinent to the case. Develops, implements and monitors a care plan through the interdisciplinary team process in conjunction with the individual member and family in internal and external settings across the continuum of care. Assesses member's status and progress routinely; if progress is static or regressive, determines reason and proactively encourages appropriate referrals to a higher level of case management or makes appropriate adjustments in the care plan, providers and/or services to promote better outcomes. Reports cost analysis, quality of care and/or quality of life improvements as measured against the case management goals. Establishes means of communication and collaboration with CalAIM providers, other team members, physicians, CBAS centers, IHSS liaisons, community agencies, health networks, skilled nursing facilities and administrators. Prepares and maintains appropriate documentation of patient care and progress within the care plan. Acts as an advocate in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals. Works collaboratively with staff members from various disciplines involved in patient care with an emphasis on interpreting and problem-solving complex cases. Documents case notes and rationale for all decisions and care coordination in the Medical Management System (i.e., JIVA, etc.). Conducts assessments by collecting in-depth information about a member's situation, identifies high-risk needs, issues and resources and gathers all information pertinent to the case to write referrals for any gaps in services. Plans and determines specific objectives, goals and actions as identified through the assessment process and makes recommendations to nursing facilities for the care of the patients. Implements goals by conducting specific interventions, including referring members to outside resources and/or community agencies that will result in meeting the goals established in the care plan. Supports implementation of the care plan through an interdisciplinary team process in conjunction with the member, family and all participants of the health care team. Monitors established measurable goals and routinely assesses the member's status and progress to proactively make appropriate recommendations for adjustments in the care plan, providers and/or services to promote better outcomes. Performs utilization review of services requested for members in case management by reviewing all pertinent medical records for medical necessity, applying medical review protocols and criteria and meeting the timeframes per the Utilization Management policies and procedures. 10% - Administrative Support Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Retrieves and monitors incoming inquiries from various sources (i.e., Zeomega Jiva care management system, email, etc.) Participates in training of internal staff and works collaboratively with other CalOptima Health departments to meet member's needs. Serves as a subject matter expert and acts as a liaison between the LTSS department and other CalOptima Health departments to assist with issues, concerns and inquiries. Ensures confidentiality of all protected health information (PHI). Maintains confidentiality of the member's medical information. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Associate degree in nursing (ADN) required. 3 years of clinical experience with the health needs of the population served required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. A valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office approximately 95% of the time. Preferred Qualifications: Bachelor's degree in nursing (BSN). 2 years of experience in LTC, community health (hospital), managed care Medi-Cal, Medicare programs or case management. Active Commission for Case Manager (CCM) certification. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Current, unrestricted Registered Nurse (RN) license to practice in the state of California required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is August 8, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/medical-case-manager-ltss-emergency-department-program-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-952e7c44de954f459ff1a1bcdaa77bcd
Medical Case Manager CalOptima CalOptima Health is seeking a highly motivated an experienced Medical Case Manager to join our team. Case Management is an advanced specialty collaborative practice responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager will facilitate communication and coordination among all participants of the health care team and CalOptima Health's members to ensure the services provided promote quality and cost-effective outcomes for all members. The incumbent will be responsible for providing intensive case management, which includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs. Position Information: Department: Case Management Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615) Work Arrangement: Full Telework **This position is eligible for telework in California.** Duties & Responsibilities: 85% - Care Management Assesses member needs using a standardized health needs assessment or health risk assessment. Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of: Member's physical, functional, social and psychological status Member's cultural and linguistic needs Caregiver resources and available benefits Performs post-discharge assessments to identify member's post-hospital or post-emergency department discharge needs including but not limited to: Member's physical, functional, social and psychological status Member's cultural and linguistic needs Caregiver resources and available benefits Follow-up provider care and ensuring scheduled appointments Durable medical equipment and supplies Community resources Develops and implements a member's specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals. Reviews, modifies and updates care plans continuously to reflect the member's needs, at minimum, annually or upon change in condition. Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goal. Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards. Coordinates care and services with members, members' family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS). Communicates with member's physicians, specialists, community agencies and vendors to ensure coordination of services. Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources. Facilitates and participates in Interdisciplinary Team meetings as applicable. Collaborates with interdepartmental staff in case resolution as needed. Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner. Advocates in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals. 10% - Administrative Support Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Follows CalOptima Health's protocol for documenting all case interventions. Prepares and maintains appropriate documentation of patient care and progress within the care plan. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Associate degree in nursing (ADN) or related field required PLUS 3 years of clinical experience and/or managed care experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Bachelor of Science in Nursing (BSN) degree or related field. Case Management Certification (CCM). Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Current, unrestricted Registered Nurse (RN) license to practice in the state of California required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 18, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/medical-case-manager-505-city-parkway-west-california-united-states-f37057b8-db66-4021-958f-eedb698e17f5 Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-75d9641c78fa8f42becd14ba50dadc02
Sep 06, 2024
Medical Case Manager CalOptima CalOptima Health is seeking a highly motivated an experienced Medical Case Manager to join our team. Case Management is an advanced specialty collaborative practice responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager will facilitate communication and coordination among all participants of the health care team and CalOptima Health's members to ensure the services provided promote quality and cost-effective outcomes for all members. The incumbent will be responsible for providing intensive case management, which includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs. Position Information: Department: Case Management Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615) Work Arrangement: Full Telework **This position is eligible for telework in California.** Duties & Responsibilities: 85% - Care Management Assesses member needs using a standardized health needs assessment or health risk assessment. Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of: Member's physical, functional, social and psychological status Member's cultural and linguistic needs Caregiver resources and available benefits Performs post-discharge assessments to identify member's post-hospital or post-emergency department discharge needs including but not limited to: Member's physical, functional, social and psychological status Member's cultural and linguistic needs Caregiver resources and available benefits Follow-up provider care and ensuring scheduled appointments Durable medical equipment and supplies Community resources Develops and implements a member's specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals. Reviews, modifies and updates care plans continuously to reflect the member's needs, at minimum, annually or upon change in condition. Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goal. Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards. Coordinates care and services with members, members' family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS). Communicates with member's physicians, specialists, community agencies and vendors to ensure coordination of services. Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources. Facilitates and participates in Interdisciplinary Team meetings as applicable. Collaborates with interdepartmental staff in case resolution as needed. Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner. Advocates in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals. 10% - Administrative Support Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Follows CalOptima Health's protocol for documenting all case interventions. Prepares and maintains appropriate documentation of patient care and progress within the care plan. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Associate degree in nursing (ADN) or related field required PLUS 3 years of clinical experience and/or managed care experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Bachelor of Science in Nursing (BSN) degree or related field. Case Management Certification (CCM). Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Current, unrestricted Registered Nurse (RN) license to practice in the state of California required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 18, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/medical-case-manager-505-city-parkway-west-california-united-states-f37057b8-db66-4021-958f-eedb698e17f5 Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-75d9641c78fa8f42becd14ba50dadc02
Medical Case Manager (Whole Child Model) (Case Management) CalOptima CalOptima Health is seeking a highly motivated an experienced Medical Case Manager (Whole Child Model) (Case Management) to join our team. Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager will facilitate communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and cost-effective outcomes for all members along with focus on members under 21 years of age. The incumbent will be responsible for providing intensive case management primarily to a pediatric population, which includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs. Position Information: Department: Case Management Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615) Work Arrangement: Full Telework **This position is eligible for telework in California.** Duties & Responsibilities: 85% - Care Management Assesses member needs using a standardized health needs assessment or health risk assessment. Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of: Member's physical, functional, social and psychological status Member's cultural and linguistic needs Caregiver resources and available benefits Performs post-discharge assessments to identify member's post-hospital or post-emergency department discharge needs including but not limited to: Member's physical, functional, social and psychological status Member's cultural and linguistic needs Caregiver resources and available benefits Follow-up provider care and ensuring scheduled appointments Durable medical equipment and supplies Community resources Develops and implements a member's specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals. Reviews, modifies and updates care plans continuously to reflect the member's needs, at minimum, annually or upon change in condition. Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goal. Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards. Coordinates care and services with members, members' family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS). Communicates with Member's physicians, specialists, community agencies and vendors to ensure coordination of services. Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources. Facilitates and participates in Interdisciplinary Team meetings as applicable. Collaborates with interdepartmental staff in case resolution as needed. Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner. Advocates in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals. 10% - Administrative Support Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Follows CalOptima Health's protocol for documenting all case interventions. Prepares and maintains appropriate documentation of patient care and progress within the care plan. 5% - Other Completes other projects and duties as assigned. Minimum Qualifications: Associate's degree in Nursing (ADN) or related field required. 5 years of clinical experience and/or managed care experience required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Bachelor of Science in Nursing (BSN) degree or related field. 2 years of pediatric experience. Certified Case Manager (CCM) certificate. Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Current, unrestricted Registered Nurse (RN) license to practice in the state of California required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is June 25, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/medical-case-manager-whole-child-model-case-management-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-8727ee184ef22a45b087d3537defe5ae
Aug 10, 2024
Full Time
Medical Case Manager (Whole Child Model) (Case Management) CalOptima CalOptima Health is seeking a highly motivated an experienced Medical Case Manager (Whole Child Model) (Case Management) to join our team. Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager will facilitate communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and cost-effective outcomes for all members along with focus on members under 21 years of age. The incumbent will be responsible for providing intensive case management primarily to a pediatric population, which includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs. Position Information: Department: Case Management Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615) Work Arrangement: Full Telework **This position is eligible for telework in California.** Duties & Responsibilities: 85% - Care Management Assesses member needs using a standardized health needs assessment or health risk assessment. Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of: Member's physical, functional, social and psychological status Member's cultural and linguistic needs Caregiver resources and available benefits Performs post-discharge assessments to identify member's post-hospital or post-emergency department discharge needs including but not limited to: Member's physical, functional, social and psychological status Member's cultural and linguistic needs Caregiver resources and available benefits Follow-up provider care and ensuring scheduled appointments Durable medical equipment and supplies Community resources Develops and implements a member's specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals. Reviews, modifies and updates care plans continuously to reflect the member's needs, at minimum, annually or upon change in condition. Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goal. Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards. Coordinates care and services with members, members' family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS). Communicates with Member's physicians, specialists, community agencies and vendors to ensure coordination of services. Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources. Facilitates and participates in Interdisciplinary Team meetings as applicable. Collaborates with interdepartmental staff in case resolution as needed. Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner. Advocates in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals. 10% - Administrative Support Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Follows CalOptima Health's protocol for documenting all case interventions. Prepares and maintains appropriate documentation of patient care and progress within the care plan. 5% - Other Completes other projects and duties as assigned. Minimum Qualifications: Associate's degree in Nursing (ADN) or related field required. 5 years of clinical experience and/or managed care experience required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Bachelor of Science in Nursing (BSN) degree or related field. 2 years of pediatric experience. Certified Case Manager (CCM) certificate. Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Current, unrestricted Registered Nurse (RN) license to practice in the state of California required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is June 25, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/medical-case-manager-whole-child-model-case-management-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-8727ee184ef22a45b087d3537defe5ae
Sr. Tableau BI Developer (Enterprise Analytics Manager) CalOptima CalOptima Health is seeking a highly motivated an experienced Sr. Tableau BI Developer (Enterprise Analytics Manager) to join our team. The Enterprise Analytics (EA) Manager will provide a "one-stop shop" for analysis, visualization, reporting, guidance and expert knowledge on health care analytics for various departments within CalOptima Health. The incumbent will work independently and in collaboration with other knowledge experts to develop report suites that are accurate in transforming various data sets into information as well as high-impact presentations utilizing Tableau to visualize results in a framework that enables decision-makers to drill-down. The incumbent will evaluate various issues, perform detailed analysis as it relates to those issues and communicate well-reasoned solutions to all levels of management within CalOptima Health. The incumbent will work with large amounts of claims, authorizations, case management, enrollment and provider data. The incumbent will have strong database, spreadsheet and business intelligence (BI) presentation skills. Position Information: Department: Financial Analysis Salary Grade: 315 - $109,892 - $175,827 ($52.83 - $84.5322) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 95% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Provides clinical and utilization analysis to assist medical management with improving outcomes and quality of care for CalOptima Health's members. Researches, assesses and develops advanced tools, models, visualizations, reports and approaches to increase accuracy and timeliness of data-driven projects. Develops return on investment and business case analyses for program initiatives under consideration by senior management. Collaborates with the Data Warehouse team to design and recommend improvements to the data warehouse. Mentors, trains and acts as a lead for more junior analytical staff. Creates models to answer "what-if" questions for changes to programs or initiatives. Partners with CalOptima Health's leaders to establish measurable improvement goals. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in computer science, data science, data analytics, business administration, economics, statistics, applied mathematics or related field required PLUS 3 years of applied expert knowledge in Tableau Desktop developing and designing dashboards to provide analytical insights; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 1 year of applied expert knowledge in SQL development (e.g., SQL queries, stored procedures and functions) required, preferably in a Microsoft SQL Server environment. Preferred Qualifications: Experience working in a healthcare analytics role. Experience working with Medi-Cal and/or Medicare payer information (e.g., claims, encounters, eligibility, authorizations, case management levels, HEDIS, etc.). Experience with ETL tools, preferably SQL Server Integration Services (SSIS). Required Licensure / Certifications: n/a Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 17, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/sr-tableau-bi-developer-enterprise-analytics-manager-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-a8f94b5395427c48a94cdd0df4026f18
Sep 05, 2024
Sr. Tableau BI Developer (Enterprise Analytics Manager) CalOptima CalOptima Health is seeking a highly motivated an experienced Sr. Tableau BI Developer (Enterprise Analytics Manager) to join our team. The Enterprise Analytics (EA) Manager will provide a "one-stop shop" for analysis, visualization, reporting, guidance and expert knowledge on health care analytics for various departments within CalOptima Health. The incumbent will work independently and in collaboration with other knowledge experts to develop report suites that are accurate in transforming various data sets into information as well as high-impact presentations utilizing Tableau to visualize results in a framework that enables decision-makers to drill-down. The incumbent will evaluate various issues, perform detailed analysis as it relates to those issues and communicate well-reasoned solutions to all levels of management within CalOptima Health. The incumbent will work with large amounts of claims, authorizations, case management, enrollment and provider data. The incumbent will have strong database, spreadsheet and business intelligence (BI) presentation skills. Position Information: Department: Financial Analysis Salary Grade: 315 - $109,892 - $175,827 ($52.83 - $84.5322) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 95% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Provides clinical and utilization analysis to assist medical management with improving outcomes and quality of care for CalOptima Health's members. Researches, assesses and develops advanced tools, models, visualizations, reports and approaches to increase accuracy and timeliness of data-driven projects. Develops return on investment and business case analyses for program initiatives under consideration by senior management. Collaborates with the Data Warehouse team to design and recommend improvements to the data warehouse. Mentors, trains and acts as a lead for more junior analytical staff. Creates models to answer "what-if" questions for changes to programs or initiatives. Partners with CalOptima Health's leaders to establish measurable improvement goals. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in computer science, data science, data analytics, business administration, economics, statistics, applied mathematics or related field required PLUS 3 years of applied expert knowledge in Tableau Desktop developing and designing dashboards to provide analytical insights; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 1 year of applied expert knowledge in SQL development (e.g., SQL queries, stored procedures and functions) required, preferably in a Microsoft SQL Server environment. Preferred Qualifications: Experience working in a healthcare analytics role. Experience working with Medi-Cal and/or Medicare payer information (e.g., claims, encounters, eligibility, authorizations, case management levels, HEDIS, etc.). Experience with ETL tools, preferably SQL Server Integration Services (SSIS). Required Licensure / Certifications: n/a Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 17, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/sr-tableau-bi-developer-enterprise-analytics-manager-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-a8f94b5395427c48a94cdd0df4026f18
Introduction This is a reinstatement, transfer or voluntary demotion opportunity for current and former regularly appointed employees of Alameda County. Reinstatement: Pursuant to Civil Service Rule 1744: On the request of a department head and approval of the Commission, a regularly appointed employee who resigned in good standing may, within three years after the effective date of his/her resignation, be reinstated in a position in the class from which he/she resigned or in a position in another class for which he/she may be eligible as determined by the Commission. Appointments by reinstatement following resignation are subject to the probationary period established for the class. You must have been a classified County employee in the same job code or in a job code at the same salary maximum and left the County in good standing. In addition, you must meet the minimum and special qualifications of the specific position. Transfer: You must be a current County classified employee in the same job code or in a job code with the same salary maximum for which you are applying. In addition, you must meet the minimum and special qualifications of the specific position. Voluntary Demotion: You must be a current County classified employee in a job code which is at a higher salary maximum than the vacancy for which you are applying. In addition, you must meet the minimum and special qualifications of the specific position. DESCRIPTION THE AGENCY Alameda County's Health Services Program is administered by the Alameda County Health and includes the following program areas: Behavioral Health Care, Public Health, Environmental Health, and Agency Administration/Indigent Health. The ultimate mission of the Health Care Services Agency is to provide fully integrated health care services through a comprehensive network of public and private partnerships that ensure optimal health and well-being and respect the diversity of all residents. Alameda County Health currently has multiple career opportunities for experienced professionals to become part of a service delivery team dedicated to the optimal health and well being of Alameda County residents. THE POSITION Under general direction, provide psychiatric clinical and case management services conduct evaluations and assessments; provide ongoing counseling, treatment and intervention; conduct individual, group and family psychotherapy; provide consultation to other programs and agencies on treatment needs and behavioral plans; and perform other duties as assigned. DISTINGUISHING FEATURES Behavioral Health Clinician I/II is a flexibly-staffed class series located in Behavioral Health Care Services (BHCS). Incumbents in this series report to a Behavioral Health Clinical Supervisor or Behavioral Health Clinical Manager. Behavioral Health Clinician II is the journey-level class in this series. Incumbents in this class are licensed clinicians and perform duties involving considerable latitude and independence of judgment under minimal supervision. Behavioral Health Clinicians II may provide direction and assistance to Behavioral Health Clinicians I and graduate interns. This class is distinguished from the next higher class of Behavioral Health Clinical Supervisor in that the latter class has supervisory responsibilities. MINIMUM QUALIFICATIONS Either I Experience: The equivalent of six-months full-time satisfactory experience in the Behavioral Health Clinician I classification in the Alameda County classified service. (Non-classified includes District Attorney's Office, Hospital Authority, and the Consolidated Courts.) Or II Experience: The equivalent of six-months of full-time post license experience as a behavioral health/mental health clinician providing clinical and/or case management services. AND Education: Possession of a Master's degree from an accredited school in social work, marriage and family therapy, psychology, counseling, nursing or related field. License/Certification: All incumbents at the Behavioral Health Clinician II level must possess a valid clinical license from the applicable licensing authority: California Board of Behavioral Sciences, California Board of Psychology, or California Board of Registered Nursing. Some positions in this class require a valid California Motor Vehicle Operator's license. Applicants must possess such license prior to appointment to such positions. Special Requirements: In compliance with the Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), employees in this classification are required to possess a National Provider Identifier (NPI) number prior to their first day on the job. In compliance with Medicare regulations,eligible licensed cliniciansin this classification are required to complete the "Medicare Enrollment Process for Physicians and Non-Physician Practitioners" through the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services, prior to their first day on the job. Active enrollment in Medicare is a condition of employment. Failure to attain or maintain active enrollment will result in termination. In compliance with the Department of Health Care Services (DHCS) and the Federal Cures Act, Employees in this classification who are required to render direct specialty mental health services in the course of their assignment must successfully be enrolled in Provider Application and Validation for Enrollment (PAVE) web portal prior to commencing employment. NOTE: The Civil Service Commission may modify the above Minimum Qualifications in the announcement of an examination. KNOWLEDGE AND SKILLS NOTE: The level and scope of the following knowledge and abilities are related to duties listed under the "Examples of Duties" section of this specification. Knowledge of: • Current theories, principles, and practices for services to clients with serious behavioral health care symptoms and diagnosis. • Psychological diagnostic methods and terminology. • Cultural and social factors affecting behavior patterns. • Wellness, recovery and resiliency oriented strategies and supports. • Dual recovery/co-occurring disorder treatment, screening and assessment tools. • Community needs, resources and organizations related to behavioral health care. • Clinical standards of practice and licensure requirements. • Principles and practices of direct client service delivery. • Principles of social needs, problems, attitudes and behavioral patterns. • Applicable federal, state and local laws, rules and regulations. • Office administrative practices and procedures, including records management and the operation of standard office equipment. • Computer applications related to the work. Ability to: • Work collaboratively with multi-disciplinary teams, community resources and organizations. • Organize and prioritize work and meet critical deadlines. • Interpret, explain, and apply regulations, policies and procedures. • Communicate clearly and effectively, both orally and in writing. • Analyze, evaluate and make sound decisions. • Prepare clear, accurate and effective reports, correspondence and other written materials. • Establish and maintain effective working relationships. • Work with a diverse population. BENEFITS Alameda County offers a comprehensive and competitive benefits package that affords wide-ranging health care options to meet the different needs of a diverse workforce and their families. We also sponsor many different employee discount, fitness and health screening programs focused on overall well being. These benefits include but are not limited to*: For your Health & Well-Being Medical - HMO & PPO Plans Dental - HMO & PPO Plans Vision or Vision Reimbursement Share the Savings Basic Life Insurance Supplemental Life Insurance (with optional dependent coverage for eligible employees) County Allowance Credit Flexible Spending Accounts - Health FSA, Dependent Care and Adoption Assistance Short-Term Disability Insurance Long-Term Disability Insurance Voluntary Benefits - Accident Insurance, Critical Illness, Hospital Indemnity and Legal Services Employee Assistance Program For your Financial Future Retirement Plan - (Defined Benefit Pension Plan) Deferred Compensation Plan (457 Plan or Roth Plan) For your Work/Life Balance 12 paid holidays Floating Holidays Vacation and sick leave accrual Vacation purchase program Catastrophic Sick Leave Group Auto/Home Insurance Pet Insurance Commuter Benefits Program Guaranteed Ride Home Employee Wellness Program (e.g. At Work Fitness, Incentive Based Programs, Gym Membership Discounts) Employee Discount Program (e.g. theme parks, cell phone, etc.) Child Care Resources 1 st United Services Credit Union *Eligibility is determined by Alameda County and offerings may vary by collective bargaining agreement. This provides a brief summary of the benefits offered and can be subject to change. Conclusion TO APPLY : Please submit a PDF of your updated Alameda Countyapplication to Sonja Ritter at sonja.ritter@acgov.org . Please be in contact if you have any questions. You are encouraged to apply immediately as this posting is open until filled and may close at anytime. Alameda County is an Equal Opportunity Employer Closing Date/Time: Continuous
Jul 09, 2024
Full Time
Introduction This is a reinstatement, transfer or voluntary demotion opportunity for current and former regularly appointed employees of Alameda County. Reinstatement: Pursuant to Civil Service Rule 1744: On the request of a department head and approval of the Commission, a regularly appointed employee who resigned in good standing may, within three years after the effective date of his/her resignation, be reinstated in a position in the class from which he/she resigned or in a position in another class for which he/she may be eligible as determined by the Commission. Appointments by reinstatement following resignation are subject to the probationary period established for the class. You must have been a classified County employee in the same job code or in a job code at the same salary maximum and left the County in good standing. In addition, you must meet the minimum and special qualifications of the specific position. Transfer: You must be a current County classified employee in the same job code or in a job code with the same salary maximum for which you are applying. In addition, you must meet the minimum and special qualifications of the specific position. Voluntary Demotion: You must be a current County classified employee in a job code which is at a higher salary maximum than the vacancy for which you are applying. In addition, you must meet the minimum and special qualifications of the specific position. DESCRIPTION THE AGENCY Alameda County's Health Services Program is administered by the Alameda County Health and includes the following program areas: Behavioral Health Care, Public Health, Environmental Health, and Agency Administration/Indigent Health. The ultimate mission of the Health Care Services Agency is to provide fully integrated health care services through a comprehensive network of public and private partnerships that ensure optimal health and well-being and respect the diversity of all residents. Alameda County Health currently has multiple career opportunities for experienced professionals to become part of a service delivery team dedicated to the optimal health and well being of Alameda County residents. THE POSITION Under general direction, provide psychiatric clinical and case management services conduct evaluations and assessments; provide ongoing counseling, treatment and intervention; conduct individual, group and family psychotherapy; provide consultation to other programs and agencies on treatment needs and behavioral plans; and perform other duties as assigned. DISTINGUISHING FEATURES Behavioral Health Clinician I/II is a flexibly-staffed class series located in Behavioral Health Care Services (BHCS). Incumbents in this series report to a Behavioral Health Clinical Supervisor or Behavioral Health Clinical Manager. Behavioral Health Clinician II is the journey-level class in this series. Incumbents in this class are licensed clinicians and perform duties involving considerable latitude and independence of judgment under minimal supervision. Behavioral Health Clinicians II may provide direction and assistance to Behavioral Health Clinicians I and graduate interns. This class is distinguished from the next higher class of Behavioral Health Clinical Supervisor in that the latter class has supervisory responsibilities. MINIMUM QUALIFICATIONS Either I Experience: The equivalent of six-months full-time satisfactory experience in the Behavioral Health Clinician I classification in the Alameda County classified service. (Non-classified includes District Attorney's Office, Hospital Authority, and the Consolidated Courts.) Or II Experience: The equivalent of six-months of full-time post license experience as a behavioral health/mental health clinician providing clinical and/or case management services. AND Education: Possession of a Master's degree from an accredited school in social work, marriage and family therapy, psychology, counseling, nursing or related field. License/Certification: All incumbents at the Behavioral Health Clinician II level must possess a valid clinical license from the applicable licensing authority: California Board of Behavioral Sciences, California Board of Psychology, or California Board of Registered Nursing. Some positions in this class require a valid California Motor Vehicle Operator's license. Applicants must possess such license prior to appointment to such positions. Special Requirements: In compliance with the Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), employees in this classification are required to possess a National Provider Identifier (NPI) number prior to their first day on the job. In compliance with Medicare regulations,eligible licensed cliniciansin this classification are required to complete the "Medicare Enrollment Process for Physicians and Non-Physician Practitioners" through the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services, prior to their first day on the job. Active enrollment in Medicare is a condition of employment. Failure to attain or maintain active enrollment will result in termination. In compliance with the Department of Health Care Services (DHCS) and the Federal Cures Act, Employees in this classification who are required to render direct specialty mental health services in the course of their assignment must successfully be enrolled in Provider Application and Validation for Enrollment (PAVE) web portal prior to commencing employment. NOTE: The Civil Service Commission may modify the above Minimum Qualifications in the announcement of an examination. KNOWLEDGE AND SKILLS NOTE: The level and scope of the following knowledge and abilities are related to duties listed under the "Examples of Duties" section of this specification. Knowledge of: • Current theories, principles, and practices for services to clients with serious behavioral health care symptoms and diagnosis. • Psychological diagnostic methods and terminology. • Cultural and social factors affecting behavior patterns. • Wellness, recovery and resiliency oriented strategies and supports. • Dual recovery/co-occurring disorder treatment, screening and assessment tools. • Community needs, resources and organizations related to behavioral health care. • Clinical standards of practice and licensure requirements. • Principles and practices of direct client service delivery. • Principles of social needs, problems, attitudes and behavioral patterns. • Applicable federal, state and local laws, rules and regulations. • Office administrative practices and procedures, including records management and the operation of standard office equipment. • Computer applications related to the work. Ability to: • Work collaboratively with multi-disciplinary teams, community resources and organizations. • Organize and prioritize work and meet critical deadlines. • Interpret, explain, and apply regulations, policies and procedures. • Communicate clearly and effectively, both orally and in writing. • Analyze, evaluate and make sound decisions. • Prepare clear, accurate and effective reports, correspondence and other written materials. • Establish and maintain effective working relationships. • Work with a diverse population. BENEFITS Alameda County offers a comprehensive and competitive benefits package that affords wide-ranging health care options to meet the different needs of a diverse workforce and their families. We also sponsor many different employee discount, fitness and health screening programs focused on overall well being. These benefits include but are not limited to*: For your Health & Well-Being Medical - HMO & PPO Plans Dental - HMO & PPO Plans Vision or Vision Reimbursement Share the Savings Basic Life Insurance Supplemental Life Insurance (with optional dependent coverage for eligible employees) County Allowance Credit Flexible Spending Accounts - Health FSA, Dependent Care and Adoption Assistance Short-Term Disability Insurance Long-Term Disability Insurance Voluntary Benefits - Accident Insurance, Critical Illness, Hospital Indemnity and Legal Services Employee Assistance Program For your Financial Future Retirement Plan - (Defined Benefit Pension Plan) Deferred Compensation Plan (457 Plan or Roth Plan) For your Work/Life Balance 12 paid holidays Floating Holidays Vacation and sick leave accrual Vacation purchase program Catastrophic Sick Leave Group Auto/Home Insurance Pet Insurance Commuter Benefits Program Guaranteed Ride Home Employee Wellness Program (e.g. At Work Fitness, Incentive Based Programs, Gym Membership Discounts) Employee Discount Program (e.g. theme parks, cell phone, etc.) Child Care Resources 1 st United Services Credit Union *Eligibility is determined by Alameda County and offerings may vary by collective bargaining agreement. This provides a brief summary of the benefits offered and can be subject to change. Conclusion TO APPLY : Please submit a PDF of your updated Alameda Countyapplication to Sonja Ritter at sonja.ritter@acgov.org . Please be in contact if you have any questions. You are encouraged to apply immediately as this posting is open until filled and may close at anytime. Alameda County is an Equal Opportunity Employer Closing Date/Time: Continuous