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FEP Behavioral Health Care Case Manager
Ref No.: 18-00500
Location: Rancho Cordova, California
Position Type:Contract
Start Date: 01/22/2018
FEP Case Manager Intermediate RN-Rancho Cordova, CA Contract to hire!

Day to Day Responsibilities of this Position and Description of Project:
  • Determines, develops and implements a plan of care based on accurate and comprehensive assessment of the member's needs related to behavioral health.
  • Applies detailed knowledge of FEP PPO and established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case.
  • Works with complex cases, promotes the delivery of quality; cost-effective health care services based on medical necessity and contractual benefits.
  • Provides guidance to the provider network.
  • Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care.
  • Coordinates Care for Lower Level of Care coordination such as Skilled Nursing Facility, Residential Treatment Center, Home Health, Home Infusion, Rehab
  • Provides disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease).
Makes referrals to Quality Management, Catastrophic Case Management and Appeals and Grievance Department

Requirements:
Education Requirement: Bachelor’s of Science in Nursing or advanced degree preferred
Required Testing: Typing WPM
Software Skills Required: PC-based software programs, Word, Excel, Outlook
Required Certifications: Prefer CCMC (Commission for Case Manager Certification)- But not required!
 
Required Skills (Top 3 to 5):
1. Registered Nurse
2. Comprehensive knowledge of case management and discharge planning
3. Specialty Training in Behavioral Health
4. Clinical Nursing Background with emphasis on behavioral health
5. Care Management experience (discharge planning, coordination of care, disease management education, home health, knowledge of community resources for behavioral health population)
6. Telephonic experience