High Intensity Case Manager Temporary in Orange at Prospect Medical Systems

Date Posted: 11/12/2020

Job Snapshot

  • Employee Type:
  • Location:
    600 City Parkway West
  • Experience:
    Not Specified
  • Date Posted:
  • Job ID:

Job Description

High Intensity Case Manager

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The scope of the High Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members' medical, environmental and psychosocial needs are optimize over the continuum of care.

Job Responsibilities/Duties

  • Identifies appropriate members for case management and conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
  • Develop an Initial Care Plan (ICP) by conditions identified in healthplan HRA, patient assessment, medical records authorizations/referrals, primary care physician, member and Interdisciplinary Care Team (ICT).
  • Setting members prioritized and self-management goals.
  • Case Manager's ability to manage a caseload consisting of a mix of chronic and high risk members.
  • Collaborate with Nurse Practitioner, Pharmacist, PCP, SPC healthplans and other IDT members. 
  • Require a minimum of 12-15 member contacts daily to assess and coordinate care. 
  • Create and manage all cases in Essette for members requiring case management and members that are in a MOC.
  • Provides appropriate documentation including but not limited to; cognitive, functional, ADL, environmental factors, psychosocial, medical and benefits ect.
  • Conducts outbound calls to assign high risk or chronic case managed members.
  • Collaborate with member's family and physicians for seamless coordination of care and services.
  • Collaborate and coordinate care with healthplans, Community Based Programs (CBAS), Multiple Long Term Support Services (MLTSS) and Behavioral Health providers.
  • Meet healthplans and NCQA requirements in turn-around-time for assessments, careplans and IDTs.
  • Monitors and evaluate effectiveness of the care management plan and modifies as necessary to meet NCQA requirements to include all required elements.
  • Interfaces with Medical Director and attends IDT as required.


Minimum Education: High School diploma or Associate degree preferred.

Minimum Experience: Two (2) years experience in case management preferably in a medical group or health plan setting.

Req. Certification/Licensure: Registered Nurse or Licensed Vocation Nurse unrestricted active license required.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit   http://pmh.com/careers/  and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm