RN Case Manager - Riverside (Must live in Riverside)

Company: SCM Associates, Inc.
Location: Riverside
Posted on: May 22, 2025

Job Description:

SummaryThe Case Manager has the responsibility to identify, assess, plan, coordinate, implement, monitor, and evaluate options and services for individuals requiring case management services. The goal of the case manager is to provide for quality, cost-effective outcomes for the client through collaboration and communication with the client, the family, the physician, and other members of the health care team. This is not a 100% remote position.Responsibilities and DutiesResponsibilities include the following:

• Processes the case utilizing client's outcome management model and tools
• Obtains written authorization for case management services as well as release of information
• Assesses the client/family to identify their strengths and resources; problems; psychosocial, financial, and medical history; current status; diagnosis; prognosis; functional status; goals; current treatment plan; and needs
• Develops a plan of care with client's model through interdisciplinary collab-oration, which identifies realistic short- and long-term goals
• Identifies, secures, and coordinates the services and resources to implement the plan
• Monitors services being provided for continued appropriateness and reports to client and carrier
• Evaluates the client's progress, the plan, and the appropriateness of the services provided, with modifications as necessary
• Provides ongoing instruction to the client and family regarding the injury/dis-ease process, treatment options, and present care
• Promotes the client's/family's self-advocacy skills to achieve maximum self-suf-ficiency
• Has knowledge of the benefit package as well as all available funding sources and systems of care and coordinates with the payer for authorization of payment
• Provides for in-depth reporting of outcomes encompassing clinical, functional, financial, and customer satisfaction areas
• Demonstrates effective, accurate, and timely verbal and written communication in all work situations
• Identifies and discloses all situations which might result in exposure to legal liability and/or are indicative of poor quality care negatively affecting the client
• Frequently requires travel to patient appointments.
• Performs other related duties as assigned in accordance with the necessary job functionSupervisory ResponsibilitiesThis position has no supervisory responsibilities.People ContactThis position requires regular contact both within the company and outside the companyin order to carry out company policies and procedures. Requires abilities of persuasionand cooperation. Often deals with persons of equal or higher rank.Decision MakingThis position requires frequent decision making and the ability to plan and perform unusualor difficult work with general operation methods/procedures.Supervision ReceivedThis position exercises considerable latitude in determining objectives and approach toassignments. Completed work is reviewed from a long-term perspective for desired results.Minimum Position QualificationsTo perform this job successfully, an individual must be able to perform each essentialduty satisfactorily. The requirements listed below are representative of the knowledge,skill, and/or ability required. Reasonable accommodations may be made to enable individualswith disabilities to perform the essential functions.Education and/or Experience:
  • Registered nurse
  • BSN preferred
  • CCM or equivalent certification preferred
  • Two years or more of related experience and/or training or equivalent combination of education and experienceLanguage Skills:
    • Ability to read, analyze, and interpret medical information, professional journals, technical procedures, governmental regulations, and standards of care
    • Ability to effectively present information and respond to questions from customers, managers, and clients as appropriateMathematical Skills:
      • Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
      • Ability to compute rate, ratio, and percent and to draw and interpret bar graphsReasoning Ability:
        • Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
        • Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule formComputer Skills:
          • Knowledge of database software, internet software, and Microsoft word processing softwareCertificates, Licenses, Registrations:
            • RN license in state(s) where cases are to be managed
            • Valid driver's license
            • Valid automobile liability insuranceOther Skills and Abilities:
              • Ability to organize and evaluate workload and prioritize projects
              • Ability to meet deadlines
              • Ability to complete multiple, simultaneous projects with accuracy and efficiency
              • Detail orientation
              • Contract-level acceptance by Paradigm of the Case Manager to manage their casesPhysical DemandsThe physical demands described are representative of those that must be met by an employeeto successfully perform the essential functions of this job. Reasonable accommodationmay be made to enable individuals with disabilities to perform the essentialfunctions.While performing the duties of this job, the employee regularly is required to sit andtalk or hear. The employee frequently is required to stand and walk. The employee frequentlyis required to use hands to finger, handle, or feel and to reach with hands andarms. The employee occasionally is required to stoop, kneel, or crouch. The employeeoccasionally must lift and/or move up to ten pounds. Specific vision abilities requiredby this job include close vision (clear vision at 20 inches or less), distance vision, peripheralvision, and ability to adjust focus.Work EnvironmentThe work environment characteristics described here are representative of those anemployee encounters while performing the essential functions of this job. Reasonableaccommodation may be made to enable individuals with disabilities to perform the essentialfunctions. The noise level in the work environment is usually moderate.At Will EmploymentEmployment at SCM Associates, Inc. is based on mutual consent, and both the employeeand SCM have the right to terminate employment at will, with or without cause, with orwithout advance notice.

Keywords: SCM Associates, Inc., San Diego , RN Case Manager - Riverside (Must live in Riverside), Executive , Riverside, California