About Us
All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. We offer a flexible work environment and schedules with work from home options. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. Additional employee paid coverage options available. We also offer paid holidays, birthday off, and unlimited PTO as well as a 401k plan.
Job purpose
As an Outpatient Case Manager, you will be responsible for coordinating and overseeing the care of patients receiving outpatient medical services. Working closely with healthcare providers, patients, and their families, you will ensure that patients receive comprehensive and coordinated care, promote continuity of care, and optimize patient outcomes.
Duties and responsibilities
· Patient Assessment: Conduct thorough assessments of patients' medical, social, and psychological needs to develop individualized care plans.
· Care Coordination: Coordinate outpatient services, including medical appointments, diagnostic tests, therapy sessions, and medication management, to ensure timely and appropriate care.
· Communication: Serve as the primary point of contact for patients, families, and healthcare providers, facilitating communication and ensuring that everyone is informed and involved in the care process.
· Advocacy: Advocate for patients' needs and rights, including access to appropriate healthcare services, community resources, and support programs.
· Resource Referral: Identify and connect patients with community resources, support groups, and other services to address social determinants of health and promote overall well-being.
· Health Education: Provide patients and their families with education and information about their conditions, treatment options, self-care strategies, and preventive measures.
· Documentation: Maintain accurate and up-to-date records of patient assessments, care plans, interventions, and outcomes in accordance with regulatory requirements and organizational policies.
· Collaboration: Collaborate with interdisciplinary healthcare teams, including physicians, nurses, therapists, social workers, and case managers, to ensure comprehensive and coordinated care.
· Quality Improvement: Participate in quality improvement initiatives, including case reviews, outcome evaluations, and performance improvement projects, to enhance the quality and effectiveness of care delivery.
· Patient Advocacy: Act as a liaison between patients, families, and healthcare providers to address concerns, resolve conflicts, and promote patient-centered care.
· Comply with UM policies and procedures. Annual review of UM policies.
· Act as clinical resources to all departments.
· Communicates with health plans, providers, members and other parties to facilitate member care treatment plan.
· Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization or appropriate services to our patients.
· Attend to provider and interdepartmental calls in accordance with exceptional customer service.
· Ability to keep high level of confidence and discretion when dealing with sensitive matters relating to providers, and members. Always maintains strictest confidentiality.
· Other duties as needed.
Qualifications
· Current licensure or certification as a Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), or equivalent, depending on the jurisdiction and requirements.
· CM and/or UM training and/or certification. Knowledge of CM standards, UM standards, Clinical Standards of Care, NCQA requirements, CMS guidelines, Milliman guidelines, and InterQual guidelines. Medi-Cal, Commercial and Medicare contracts and benefit interpretation is preferred.
· Five years+ clinical experience.
o Prefer of two (2) years+ experience in an HMO/IPA/Managed care setting is preferred and recommended.
· Excellent communication, interpersonal, and problem-solving skills, with the ability to interact effectively with patients, families, and healthcare professionals.
· Ability to work independently and collaboratively in a fast-paced environment, prioritizing tasks and managing multiple responsibilities effectively.
· Commitment to patient-centered care, cultural competence, and ethical practice.
· Process oriented.
· Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe
· Detail oriented and highly organized
· Strong ability in problem-solving
· Ability to self-manage, strong time management skills
· Ability to work in an extremely confidential environment
· Strong written and verbal communication skills
Education and Additional Requirements
· Valid CA and/or Texas/Multi State Registered Nurse license, Licensed Clinical Social Worker (LCSW), or equivalent.
Working conditions
· This job may require flexible work hours due to the nature of the responsibilities
· Candidate must be comfortable with ambiguity and open to working in a collaborate environment
Physical requirements
· Sitting/standing for extended periods of time.
Salary Range
· $90,000 - $130,000 annually (RN)
· $70,000 - $95,000 annually (LVN)
Job Type: Full-time
Pay: $70,000.00 - $130,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Application Question(s):
- Do you hold a valid CA and/or Texas/Multi State Registered Nurse license or are you a licensed Clinical Social Worker (LCSW)?
- Do you have at least two (2) years+ experience in an HMO/IPA/Managed care setting?
Work Location: Remote