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GENERAL DESCRIPTION OF POSITION The RN Case Manager is responsible for providing on-going case management services for Santa Clara Family Health Plan (SCFHP) members. As a SCFHP member advocate, the RN Case Manager facilitates communication and coordination among all participants of the care team to ensure member identified goals and needed services are provided to promote quality cost-effective outcomes. Through the development and implementation of member individualized care plans, the RN Case Manager provides medical and psychosocial case management support to help coordinate resources and services for individuals across the healthcare and social services continuum, and facilitate the use of available healthcare benefits in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements.

ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

Conduct, review and document comprehensive clinical and/or psychosocial assessments and on-going follow-up interventions to measure progress towards meeting goals as they relate to a member’s physical, psychosocial, environmental, safety, developmental, cultural and linguistic needs. Maintain case files by assuring that they are documented in accordance with SCFHP policies and procedures, state and federal requirements and organized in a manner that adheres to standards for audit requirements. Facilitate involvement of the member and/or family/responsible party for development and implementation of a member specific care plan which includes individualized prioritized goals. Coordinate member’s care with PCP, Specialists, Behavioral Health and Long Term Services and Supports providers to assist member to achieve or maintain a level of functional independence which allows them to remain at home or in the community. Facilitate and coordinate communication with member’s interdisciplinary care team including SCFHP internal staff, as well as the member’s physicians, specialists, public services, community agencies and vendors to ensure care plan development and coordination of benefits and services.

REQUIREMENTS – Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

Active California RN License without restriction. (R) Minimum three years of experience in case management, discharge planning, or education or certifications, or equivalent experience. (R) Knowledge of managed care principles and practices with emphasis in Utilization Management and/or Case Management. (R) Clinical knowledge and critical thinking skills with the ability to assess individualized whole-person care needs necessary to develop an effective care plan. (R) Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R) Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D) Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities, children). (D) Ability to work within an interdisciplinary team structure. (R) Ability to conduct home, facility and other community-based visits. (R)

Santa Clara Family Health Plan (SCFHP) is a local, community-based health plan dedicated to improving the health and well-being of the residents of Santa Clara County. Working in partnership with providers and community organizations, we serve our neighbors through our Medi-Cal and SCFHP DualConnect (HMO D-SNP) health care plans.