CMT Care Manager, RN Job at SAC Health in San Bernardino

Who We Are:

SAC Health empowers our patients and their families to live vibrant and healthy lives through culturally responsive, exceptional care. Patient-centered, whole-person care. Our unique, full scope, team-based approach is what makes SAC Health the provider of choice for patients.

Top-Tier Patient Satisfaction Scores | Largest Teaching Health Center FQHC | 11 Locations offering 44 Specialties | NCQA Patient-Centered Medical Home Level 3 Certified Multi-Site Approved for NHSC & NCLRP loan forgiveness programs - NHSC/Nurse Corps/Pediatric Specialty | HPSA Scores: Primary: 17 | Dental: 25 | Mental: 20

What We Are Looking For

As a member of the Care Management Team, the CMT Care Manager, RN is responsible for the clinical coordination of high-risk patients, such as, but not limited to, homelessness, chronic medical, behavioral, substance use health conditions, social determinates of health issues, children and/or youth, and individuals with post-incarceration. The CMT Care Manager, RN will engage patients with both acute and chronic diseases to develop plans of care addressing the patient's changing needs and conditions. The RN will maintain a broad perspective of patient care by identifying and evaluating patient needs across medical, behavioral and social areas. This position will utilize specialized care management and utilization management methodologies with application in every-day practices. Will serve has a role model to other Care Management Team members through mentorship and training opportunities.

Schedule: 5 days per week, 8 hours per day, Monday - Friday, 7:30 am-4:00 pm | Location: San Bernardino, CA

ESSENTIAL FUNCTIONS AND DELIVERABLES

• Reviews the patient's electronic medical record to provide quality care through developing, implementing and evaluating individual patient and formulates with the provider a plan of care appropriate for the patient.
• Communicates with other case managers/program managers i.e. (IEHP), health professionals and coordinators with regard to patient's situation. Facilitates and ensure recommendations are communicated across the healthcare team.
• Collaborates with physicians, other health care professionals (therapists, social services, pastoral care, and supportive services), clients, and families in developing a comprehensive, coordinated plan for care.
• Communicates, supports and encourages patient activation towards achievement of health goals. Provides evidence-based practice.
• Assists with the development of goals and objectives of the SACH clinics as it pertains. Continuum of patient care. May assist with triaging patients when necessary.
• Monitor and promote effective utilization of healthcare resources through EMR and clinical measures. Tracks medical and behavioral health outcomes of the patients.
• Manages both acute and chronic diseases; reevaluates plan of care and ensures continued appropriateness based on the patients' changing needs and condition.
• Gathers input from other care management team members to prioritize patient cases for systematic population/caseload.
• Oversees the Patient Navigator and Care Coordinators on the team. Responsible for ensuring that the team works cohesively.
• Maintains working knowledge of specialized case and utilization management methodologies and practices; applies concepts to everyday practice.
• Serves on assigned committees as appointed, and actively participates in meetings and outside activities as delegated.
• Works with all levels of staff to ensure SACH program measures are being met.
• Assists to develop policies/procedures, clinical guidelines, ancillary guidelines, etc., for patient care; reviews and revises as indicated.
• Ensures medical appropriateness criteria (intensity of service and severity of illness) are met for the level of care provided and are documented for each encounter.
• Other duties as outlined in the official job description.

QUALIFICATIONS:

• Education: Associate of Science Degree in Nursing required. A Bachelor in Nursing (BSN) degree is preferred.
• Licensure/Certification: Current and unrestricted California Registered Nursing License, current CPR/BLS certification (must be American Heart Association or Red Cross accredited program), valid California driver's license, good driving record and active auto insurance. As a requirement of this position, you must receive EPIC certification for the module you have been hired into.
• Experience: 3+ years of acute care, hospital-based experience required. Bilingual in English and Spanish preferred.
• Essential Technical/Motor Skills: Must be proficient in MS Office Suite (Word, Excel, PowerPoint, Outlook). Must be able to use widely support internet browsers. Must have the ability to use variations of electronic health records and other various databases.
• Interpersonal Skills: Able to relate and communicate positively, effectively, and professionally with others; be assertive and consistent in following and/or enforcing policies; work calmly and respond courteously when under pressure; lead, supervise, teach, and collaborate; accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; perform basic math functions; manage multiple assignments effectively; compose written material; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision.
• Work Eligibility: Must be legally authorized to work in the United States on a full-time basis. Must not now or in the future require sponsorship for employment visas.

EEO: SAC Health is committed to fostering a diverse, equitable and inclusive work environment and is committed to being an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Full Benefits Package Effective on Your First Day!

Industry Leading PTO Accrual (accrued per pay period) | Sick Leave | Paid Holidays | Paid Jury Duty, Bereavement | SAC Health Covers approximately 85% of Team Member health premium costs (may vary w/benefit plan selection) | Retirement - up to 8% employer contribution | Continuing Education and Learning Benefits | Annual Mission Trip and much more!

Learn More About the Work We Do:

SAC Health's Mission: SAC Health's mission is to reflect the healing ministry & love of Jesus Christ through healthcare, education & partnerships that empower our communities to flourish.

SAC Health's Core Values: Quality Healthcare - Teamwork - Wholeness -Integrity - Compassion - Excellence - Humble Service - Respect