RN Full-time
Inland Empire Health Plan

Care Manager, RN - Health Access, ECM - Rancho Cucamonga (Remote)

Inland Empire Health Plan CA
Overview: What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Reporting to Health Access Enhanced Care Management Department Leadership, this position is responsible for working effectively with the Health Access Enhanced Care Management (ECM) Care Coordination team, members and families, other professionals, and the designated healthcare care organization (HCO) medical team to provide high quality, effective care management to IEHP members. This position focuses on a person-centered model of care which takes in to account the member’s medical, behavioral, and social needs. This position provides high quality, effective care management to IEHP members ensuring coordinated continuous care. Care Management is broadly defined, and can include outreach and engagement to members, engaging members in skilled therapeutic interactions to promote health behaviors, other behavioral health interventions within scope, coordination of care, resource linkages, working with other professionals, and organizations in the community to ensure quality of care for members, seamless transitions of care, and facilitating the right care and the right time for the member. As a licensed clinician, this position provides clinical expertise, clinical leadership, and clinical oversight in a variety of ways within the Enhanced Care Management program. This position, like all positions within the HA ECM team, is expected to model behavioral health principles of relationship-based care, as well engage in promoting education and understanding of behavioral health and its importance in whole health, to those within IEHP and in the community. This is a field-based position in which Care Team Members will meet with our highest risk/high utilizer population face to face, per member's consent. The individual in this position is to utilize their clinical expertise to support and engage members to promote positive health behaviors, assist with coordination of care, provided resource linkages, and collaborate with other Team Members within their care team, as well as external partners, to ensure a seamless transition of care experience. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits: Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more Competitive salary State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account – Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities: Exercise independent clinical judgment and strategic planning in managing a caseload of members with medical needs according to department processes and procedures. Recommend care coordination strategies for members, including but not limited to: Utilize clinical tools and metrics (i.e., brief medical interventions) as necessary to inform interventions, manage caseloads, and escalate high-risk cases appropriately. Engage with members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the member and his or her medical/behavioral team, as well as improving the member’s ability to manage and control their whole health. Conduct comprehensive, holistic assessment according to the scope of the RN license. Assimilate assessment information into an individualized care plan (ICP), communicate ICP with members, approved family or caregiver, and other members of the care team. Lead inter/transdisciplinary care team meetings to share information, update and inform care plan Coordinate with internal and external health partners to support Members comprehensive care needs Participate and lead care transition plan responsibilities Assist with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services Coordinate care for members with complex medical and social needs, including across the physical, behavioral, and dental health delivery systems Provide formal and informal training and support for Health Access Team Members on medical conditions, including treatments and evidence-based for treatment. Provide clinical consultation and support for Health Access ECM Team Members on physical health conditions, including evidence-based care Represent the Enhanced Care Management team as the lead member when necessary Develop interventions to improve the member’s ability to manage their own health Support the clinical scope of responsibilities for non-clinically licensed care Team Members within the RN scope of practice Cultivate and sustain productive partnerships with providers, team members, and community stakeholders. Employ advanced communication methods to strengthen collaboration across in-person, telephonic, and digital platforms. Model supportive and collaborative relationships with Members, co-workers, and community relations Promote a collaborative and effective working environment within the Health Access Enhanced Care Management team by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as arise, and collaborating on Member case discussions Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as identifying and addressing performance indicator measures, HEDIS gaps, and other quality measures Participate in staff meetings, trainings, committee meetings, or other activities as needed or as directed by Leadership Ensure documentation is accurate and in compliance with regulatory requirements and accreditation standards Perform any other duties as required to ensure Health Plan operations and department business needs are successful Qualifications: Education & Requirements Three (3) or more years of care management experience in a health care delivery setting required. Experience working successfully within a team, and experience in developing and maintaining effective relationships with both clients and coworkers is mandatory Experience in a Managed Care setting preferred Minimum of one (1) year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred Population of Focus Experience: Adults, unaccompanied youth & children, and families experiencing homelessness Adults, youth, and children who are at risk for avoidable hospital or ED care Adults, youth, and children with serious mental health and/or substance use disorder needs Adults living in the community and at risk for long-term care institutionalization Adult nursing facility residents transitioning to the community Children & youth enrolled in CCS or CCS Whole Child Model with additional needs beyond their CCS conditions Children & youth involved in child welfare (foster care) Adults & youth who are transitioning from incarceration Pregnant & postpartum individuals; birth equity population of focus Associate’s degree in Nursing from an accredited institution required Bachelor’s degree in Nursing from an accredited institution preferred Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required Certified Case Manager (CCM) preferred Key Qualifications Must have a valid California Driver’s license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points Strong knowledge and in-depth understanding of: Skill in evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies Understanding of and sensitivity to multi-cultural community Self-management philosophies and practices, especially as they relate to chronic medical conditions Awareness of the impact of unmitigated bias and judgement on health; commitment to addressing both Bilingual (English/ “Target Language”) preferred Highly skilled interpersonally, with excellent relationship skills Highly skilled in interpersonal communication, including resolving conflict with co-workers Skillful in informally and formally sharing expertise Must have skills to tolerate, manage and make effective use of a high level of ambiguity around new team models, new models of care, and new care management practices Start your journey towards a thriving future with IEHP and apply TODAY ! Work Model Location: Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Significant travel outside of the office to Providers offices, member’s homes, and out to the community. Must live within a 25-mile radius of the assigned service area and have reliable transport Pay Range: USD $91,249.60 - USD $120,910.40 /Yr.
LVN Full-time
Inland Empire Health Plan

Care Manager, LVN

Inland Empire Health Plan CA
Overview: This position is a Short-term Assignment with IEHP. What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the general direction of department leadership, the Care Manager, LVN is responsible for working directly with the IEHP members, IPA medical groups, providers, hospitals, community agencies, and other entities supporting member care to ensure coordinated care and serve as a resource person for internal and external entities. The Care Manager, LVN works closely with the multidisciplinary care team to support members during the care coordination and care management process. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits: Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account – Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities: Serve as a resource for IEHP members and providers for care management and care coordination. Screen members for appropriate care management needs, documenting findings and communicating with the rest of the care team. Use approved screening tools which contribute to the assessment (i.e., Health Risk Assessment or other designed tools). Contribute to the development and modification of the Individualized Care Plan (ICP) including: Review ICP recommendations with RN Care Manager Team Member and other Interdisciplinary Care Team (ICT) members as appropriate. Educate members according to approved plan and material content. Communicate unexpected results with RN Care Manager Team Member and other ICT members as appropriate. Assist members with immediate needs with regard to access, referrals and authorizations. Act as a member advocate at all times. Assist with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services. Model the highest ethical behavior in relationships with co-workers, supervisors, members, providers, and colleagues in the community. Build and maintain a positive working relationship with providers, community agencies, and internal colleagues through all modes of communication (e.g., communication via in-person, over the phone, and through digital means such as email and fax). Promote a collaborative and effective working environment within the Team by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as they arise, and collaborating on member case discussions. Engage with members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the member and his or her medical/behavioral team, as well as to increase the member’s sense of control over their whole health. Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as by identifying and addressing HEDIS gaps, and by identifying, developing, and testing new practices for improving member health outcomes. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications: Education & Requirements Three (3) or more years of care management experience in a health care delivery setting required Current IEHP Team Members who have worked at least two (2) years in the Care Management department and are currently successful in their work performance during the last two (2) years, may be considered for this position in lieu of the minimum three (3) year experience requirement Experience in an HMO or experience in Managed Care setting preferred. Minimum one (1) year clinical experience in and acute care facility, skilled nursing facility, home health or clinic setting preferred High school diploma or GED required Associate’s degree from an accredited institution preferred Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians required Valid California Driver’s License preferred Key Qualifications Working knowledge of health care delivery systems Working knowledge of PC applications including MS Office Suite and other supportive technology. Written and oral communication skills Proven ability to: Read and interpret data Analyze problems and formulate appropriate plans, solutions, and courses of action Establish and maintain cooperative working relationships with individuals at all levels of the organization and members Maintain confidentiality of members and all related entity business matters of the organization Be detail oriented Start your journey towards a thriving future with IEHP and apply TODAY ! Work Model Location: Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.) Pay Range: USD $63,897.60 - USD $83,075.20 /Yr.
RN Full-time
Inland Empire Health Plan

Grievance & Appeals Nurse, RN (Remote)

Inland Empire Health Plan CA
Overview: What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Reporting to the Supervisor, Grievance & Appeals, the Grievance & Appeals Nurse, RN (G&A Nurse, RN) is responsible for working directly with the IPAs, Hospitals, internal IEHP departments, and the Grievance team to ensure Grievance and Appeal cases are processed per the Grievance Policy & Procedures and Department of Managed Health Care (DMHC)/ Department of Health Care Services (DHCS)/ Center for Medicare and Medicaid Services (CMS) regulations and NCQA. This position coordinates care, within the scope of their licensure, of members in conjunction with the member’s PCP and IPA and/ or IEHP Team Members to provide continuous Quality-Of-Care and assist in the development of quality initiatives. The incumbent serves as a resource person to IEHP personnel, as well as external practitioners and providers. When designated, the G&A Nurse, RN will also be responsible for triaging and assigning Grievance and Appeals cases to ensure timeliness and regulatory requirements are met. The G&A Nurse, RN will support appropriate Grievance case categorization inclusive of Quality of Care, identification of member harm, in addition to the completion of required reporting to internal departments (e.g. Critical Incidents and Potential Quality Incidents) and external mandatory reporting (e.g. CPS and APS). Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits: Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary CalPERS retirement State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account – Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities: Serve as a subject matter expert for Grievance and Appeals (G&A) and IEHP departments and is a resource for clinical and non-clinical Team Members in expediting the resolution of outstanding issues. Work closely with the Grievance & Appeals Team under the direction of the Grievance Nurse Leadership with Member Services, Provider Services, Compliance, Medical Services Departments, and DMHC/DHS/CMS to ensure all member grievance issues are investigated, and care is coordinated appropriately and in adherence to Grievance and Appeals Policies and Procedures. Directly communicate with IEHP Medical Directors. Resolve medical grievance and appeal cases, in conjunction with IEHP staff, Grievance Management, and Providers, as applicable. Responsible for initial medical review and clinical oversight of all received team cases. Triage new cases to identify medical urgency, Member Harm, appropriate reporting (e.g. APS & CPS) and the potential need for Organizational Determination and notify the Immediate Needs team to ensure timely resolution. Review Grievance & Appeal case categorization and classification to ensure it is accurate, assist in the resolution of member medical issues and assist with coordination of care with all practitioners, Providers and entities/agencies involved in the member’s care. Comply with mandated reporting obligations and serve as the first line to report allegations of physical and sexual abuse to the appropriate authorities. Identify case issues, assist in developing quality initiatives, referrals to outside agencies, other system issues within Grievances and Appeals and referring to appropriate IEHP Team Members. Assist with interpreting departmental policies, procedures, regulations, benefits (including evolving benefits), and other processes for IEHP members. Notify Grievance & Appeals management of any identified trends related to contracted practitioners and Providers to assure continuity of care for identified IEHP members. Work with Team Members to support the protocols and goals of the department and the vision of the organization. Ensure clinical oversight of assigned Grievance and Appeals team cases specific to accurate and appropriate categorization of Quality-of-Care grievance cases and timely identification of Member Harm. Provide direction/guidance to G&A LVNs as it pertains to Quality-of-Care categorization and mis-categorization, Member Harm, Immediate Needs, PQI/Critical incident identification and reporting. Ensure all necessary follow up is tasked for completion by designated MedHOK business partners, to include timely reporting of critical incidents, potential quality incidents and provider preventable conditions Generate written correspondence to Providers, members, and regulatory entities utilizing approved templates with use of appropriate grammar and punctuation. Prepare files for Grievance and Appeals Committee reviews. Maintain all Grievance & Appeals documentation according to external agency requirements. Audit daily reports to assure all Quality-of-Care grievance and appeal cases are captured and opened within regulatory timeframes, to include the identification of Member Harm. Prepare and finalize administrative appeal cases to include final review decision, appropriate application of review criteria and final resolution to member and requesting Provider. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications: Education & Requirements Two (2) or more years of experience as an RN in case management, utilization management in managed care setting or related experience in a health care delivery setting required Two (2) or more years of experience as an RN in clinical nursing in a hands-on patient care delivery setting required Associate's Degree in Nursing from an accredited institution required Bachelor's Degree in Nursing from an accredited institution preferred Minimum possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California Board of Registered Nursing required Key Qualifications Knowledge of: Outside agencies and resources such as CCS, CMS, DMHC, or DHCS Patient rights and ethical decision-making frameworks Medical necessity and level of care, chronic disease and complex clinical cases Diagnostic and procedural understanding in a clinical setting Regulatory guidelines surrounding grievances and appeals per CMS, DHCS, and DMHC and NCQA Member and Provider legal rights to access the grievance and appeals resolution process, within the respective Provider Organization, DHCS, DMHC, and CMS, and/or IEHP Microcomputer applications: spreadsheet, database, and word processing; Excellent interpersonal and communication skills Time management and priority setting skills Proven ability to: Demonstrate a commitment to incorporate LEAN principles into daily work Work effectively with various internal departments and external Providers and entities Assess complex Grievance & Appeal cases and recommend appropriate action Analyze documentation of incoming cases to determine appropriateness of care and applicable next steps Effectively escalate issues as identified, following established protocols Maintain a positive attitude and work in a team setting Word processing and data entry involving computer keyboard and screens, automobile travel within the Inland Empire While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus Start your journey towards a thriving future with IEHP and apply TODAY ! Work Model Location: Telecommute (All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Pay Range: USD $91,249.60 - USD $120,910.40 /Yr.
RN Full-time
Inland Empire Health Plan

Quality Improvement, RN (Hybrid with site visits)

Inland Empire Health Plan Rancho Cucamonga, CA
Overview: What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Reporting to Director of Hospital Relations, the Quality Improvement, RN will facilitate quality improvement initiatives across the continuum of care (i.e. acute care hospitals, skilled nursing facilities, hospice agencies, etc.) to enhance the overall quality of care delivered to members. This position is responsible for identifying, developing, coordinating, promoting, supporting, and implementing assigned clinical quality, and/or service improvement projects and programs. The Quality Improvement, RN supports evidence-based practice integration, provider training/education, policy review/development, and regulatory/accreditation interpretation. The incumbent develops continuous and targeted activities to improve performance related to Centers for Medicare & Medicaid Services (CMS) Star Ratings, HEDIS, CAHPS, HOS, P4P and other identified performance measures. The Quality Improvement, RN provides direct support for multiple initiatives aimed at improving the quality and effectiveness of health care delivery and/or health care services. This position communicates with external partners, internal quality leaders, and stakeholders to ensure multi-disciplinary teams have the resources and information they need. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits: Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account – Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities: Participate in departmental and cross-functional teams; this includes supporting IEHP and external stakeholder workgroups that focus on quality improvement projects. Assist in tracking progress for improvement efforts related to Hospital value-based incentives (P4P, VBI, VBP, etc.), network-wide CMS star ratings, and specific performance metrics. Coordinate activities to foster good working relationships with contracted hospitals, skilled nursing facilities, hospice agencies, providers, and other external partners to encourage their participation in quality improvement groups. Help organize forums for shared learning and best practice exchange to improve patient care outcomes. Apply knowledge of clinical processes or hospital operations to support the development and implementation of specific activities (based on current results and best practices) intended to improve CMS Star Ratings, HEDIS, CAHPS, HOS, P4P, and other targeted performance measures. Gather and compile information on evidence-based practices, national and regional benchmarks, and industry standards, and help integrate those findings into current improvement initiatives. Track and monitor improvement activities by performing ongoing analysis of measured outcomes and reporting findings. Compile and summarize performance outcomes data and draft initial feedback for review by senior staff before distribution to external partners regarding improvement progress. Utilize performance improvement methodologies (i.e., Plan Do Study Act (PDSA)) to support the implementation and tracking of rapid-cycle improvement projects. Participate in outreach initiatives, and document potential barriers, experienced challenges, and activities taken to resolve issues and improve outcomes. Assist in the maintenance and organization of annual quality improvement program documents, compliance audits, policies and procedures, and related evaluations. Support the development and delivery of materials for quality improvement training sessions and problem-solving tool workshops for QI teams and stakeholders. Lead intradepartmental quality improvement teams, programs, projects, and initiatives as assigned. Continuously seek to enhance delivery and efficiency of external-facing quality improvement initiatives via technological advancement and internal-facing process improvement. Translate data into meaningful information, draw conclusions, and relate findings to industry standards. Provide recommendations to departmental stakeholders and Quality Improvement Leadership Team regarding performance gaps, program implementation, and performance outcomes in order to maintain an effective Quality Improvement program. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications: Education & Requirements Minimum four (4) years of clinical/health care experience required, including at least two (2) years performing quality improvement analysis or project coordination functions Bachelor’s degree in science or health/healthcare related field from an accredited institution required Master’s degree in science or health/healthcare related field from an accredited institution preferred Certified Professional of Healthcare Quality (CPHQ), or other recognized quality improvement certificate required or obtained within one (1) year of hire (maintained through employment) Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required Key Qualifications Working knowledge of healthcare quality performance and measurement sets including CMS quality withhold, Managed Care Accountability Set, NCQA Quality Improvement Standards and HEDIS Ability to apply knowledge of tools of continuous improvement, and work process redesign Knowledge of advanced clinical processes and/or hospital operations Requires knowledge of the local healthcare market, patient demographics and needs and plan-specific information Good analytical and critical thinking skills Proficient in all Microsoft Office applications, with an emphasis on Excel and PowerPoint Effective communication skills (verbal, written and listening) with ability to interact with key stakeholders Must exhibit attention to detail Ability to successfully apply facilitation techniques to quality improvement project teams Demonstrates problem solving, conflict management, and team collaboration to contribute to a productive work environment and achievement of goals Ability to read and interpret data Able to manage and prioritize assigned tasks and work efficiently under pressure to meet deadlines in a fast-paced environment Ability to support the application of basic facilitation techniques within quality improvement project groups Start your journey towards a thriving future with IEHP and apply TODAY ! Work Model Location: This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.) Pay Range: USD $91,249.60 - USD $120,910.40 /Yr.
RN Full-time
Inland Empire Health Plan

Quality Program Nurse, RN (Remote with field work)

Inland Empire Health Plan CA
Overview: What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Manager, Quality Management Nurses, Quality Program Nurses (QPN) are responsible for the implementation of Quality Management policies, procedures, and activities. QPN’s enforce DHCS regulatory requirements as pertaining to Facility Site Review (FSR) and Medical Record Review (MRR) criteria. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits: Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account – Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities: Perform initial, periodic, and verification Site Review and Medical Record Surveys for assigned Primary Care Providers. Conduct other regulatory audits as assigned. Review Primary Care Provider Corrective Action Plans (CAP) submissions and monitor CAP compliance. Perform focused audits as directed by IEHP Subcommittees. Perform annual HEDIS data abstractions. Monitor assigned PCPs for potential problem hours and document findings. Review QM reports and CAP log on a weekly basis. Responsible for Provider compliance and follow up. Attendance and participation in Quality Management Committee and/or Subcommittee meetings, as needed. Attend Site Review and Medical Record Survey training, as mandated by DHCS, to maintain and become a Certified Site Reviewer. Attendance and participation in Quality Management, Medical Services, and other inter-departmental staff meetings as indicated. Attendance and participation in Quality Management Committee or Subcommittee meetings, as directed. Any other duties as required to ensure Plan operations are successful. Qualifications: Education & Requirements Three (3) or more years of any individual or combined experience in Quality Assurance, Utilization Management, Case Management, provider liaison duties, and/or clinical experience in a hospital/clinical setting Experience preferably in an HMO or Managed Care setting Associate’s degree in Nursing from an accredited institution required Bachelor’s degree in Nursing from an accredited institution preferred Possession of valid Certified Site Reviewer Certificate issued from DHCS or participating Medi-Cal Managed Health Plan Provider If not a CSR, the candidate should be willing and able to get certified within 6 months of hire Possession of an Active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required Valid State of California driver's license and valid automobile insurance Key Qualifications Knowledgeable and understanding of nursing principles & evidence based practices Computer applications: spreadsheet, database, and word processing. Strong organizational, time-management, and critical thinking skills Excellent written and verbal communication and interpersonal skills. Highly skilled in interpersonal communication, including conflict resolution. Minimal to moderate physical activity; may include standing, bending, sitting for long periods of time and repetitive motion Ability to manage multiple projects with completing deadlines and changing priorities Automobile travel within the Inland Empire May periodically be required to report to IEHP’s main campus for in-person meetings or for other business needs as determined by IEHP leadership Start your journey towards a thriving future with IEHP and apply TODAY ! Work Model Location: Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Automobile travel within the Inland Empire May periodically be required to report to IEHP’s main campus for in-person meetings or for other business needs as determined by IEHP leadership Pay Range: USD $91,249.60 - USD $120,910.40 /Yr.
LVN Full-time
Inland Empire Health Plan

Care Manager, LVN (Remote)

Inland Empire Health Plan CA
Overview: What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the general direction of department leadership, the Care Manager, LVN is responsible for working directly with the IEHP members, IPA medical groups, providers, hospitals, community agencies, and other entities supporting member care to ensure coordinated care and serve as a resource person for internal and external entities. The Care Manager, LVN works closely with the multidisciplinary care team to support members during the care coordination and care management process. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits: Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account – Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities: Serve as a resource for IEHP members and providers for care management and care coordination. Screen members for appropriate care management needs, documenting findings and communicating with the rest of the care team. Use approved screening tools which contribute to the assessment (i.e., Health Risk Assessment or other designed tools). Contribute to the development and modification of the Individualized Care Plan (ICP) including: Review ICP recommendations with RN Care Manager Team Member and other Interdisciplinary Care Team (ICT) members as appropriate. Educate members according to approved plan and material content. Communicate unexpected results with RN Care Manager Team Member and other ICT members as appropriate. Assist members with immediate needs with regard to access, referrals and authorizations. Act as a member advocate at all times. Assist with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services. Model the highest ethical behavior in relationships with co-workers, supervisors, members, providers, and colleagues in the community. Build and maintain a positive working relationship with providers, community agencies, and internal colleagues through all modes of communication (e.g., communication via in-person, over the phone, and through digital means such as email and fax). Promote a collaborative and effective working environment within the Team by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as they arise, and collaborating on member case discussions. Engage with members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the member and his or her medical/behavioral team, as well as to increase the member’s sense of control over their whole health. Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as by identifying and addressing HEDIS gaps, and by identifying, developing, and testing new practices for improving member health outcomes. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications: Education & Requirements Three (3) or more years of care management experience in a health care delivery setting required Current IEHP Team Members who have worked at least two (2) years in the Care Management department and are currently successful in their work performance during the last two (2) years, may be considered for this position in lieu of the minimum three (3) year experience requirement Experience in an HMO or experience in Managed Care setting preferred. Minimum one (1) year clinical experience in and acute care facility, skilled nursing facility, home health or clinic setting preferred High school diploma or GED required Associate’s degree from an accredited institution preferred Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians required Valid California Driver’s License preferred Key Qualifications Working knowledge of health care delivery systems Working knowledge of PC applications including MS Office Suite and other supportive technology. Written and oral communication skills Proven ability to: Read and interpret data Analyze problems and formulate appropriate plans, solutions, and courses of action Establish and maintain cooperative working relationships with individuals at all levels of the organization and members Maintain confidentiality of members and all related entity business matters of the organization Be detail oriented Start your journey towards a thriving future with IEHP and apply TODAY ! Work Model Location: Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Pay Range: USD $63,897.60 - USD $83,075.20 /Yr.
RN Full-time
Inland Empire Health Plan

Care Manager, RN - Health Access, ECM

Inland Empire Health Plan CA
Overview: What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Reporting to Health Access Enhanced Care Management Department Leadership, this position is responsible for working effectively with the Health Access Enhanced Care Management (ECM) Care Coordination team, members and families, other professionals, and the designated healthcare care organization (HCO) medical team to provide high quality, effective care management to IEHP members. This position focuses on a person-centered model of care which takes in to account the member’s medical, behavioral, and social needs. This position provides high quality, effective care management to IEHP members ensuring coordinated continuous care. Care Management is broadly defined, and can include outreach and engagement to members, engaging members in skilled therapeutic interactions to promote health behaviors, other behavioral health interventions within scope, coordination of care, resource linkages, working with other professionals, and organizations in the community to ensure quality of care for members, seamless transitions of care, and facilitating the right care and the right time for the member. As a licensed clinician, this position provides clinical expertise, clinical leadership, and clinical oversight in a variety of ways within the Enhanced Care Management program. This position, like all positions within the HA ECM team, is expected to model behavioral health principles of relationship-based care, as well engage in promoting education and understanding of behavioral health and its importance in whole health, to those within IEHP and in the community. This is a field-based position in which Care Team Members will meet with our highest risk/high utilizer population face to face, per member's consent. The individual in this position is to utilize their clinical expertise to support and engage members to promote positive health behaviors, assist with coordination of care, provided resource linkages, and collaborate with other Team Members within their care team, as well as external partners, to ensure a seamless transition of care experience. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits: Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account – Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities: Exercise independent clinical judgment and strategic planning in managing a caseload of members with medical needs according to department processes and procedures. Recommend care coordination strategies for members, including but not limited to: Utilize clinical tools and metrics (i.e., brief medical interventions) as necessary to inform interventions, manage caseloads, and escalate high-risk cases appropriately. Engage with members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the member and his or her medical/behavioral team, as well as improving the member’s ability to manage and control their whole health. Conduct comprehensive, holistic assessment according to the scope of the RN license. Assimilate assessment information into an individualized care plan (ICP), communicate ICP with members, approved family or caregiver, and other members of the care team. Lead inter/transdisciplinary care team meetings to share information, update and inform care plan Coordinate with internal and external health partners to support Members comprehensive care needs Participate and lead care transition plan responsibilities Assist with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services. Coordinate care for members with complex medical and social needs, including across the physical, behavioral, and dental health delivery systems. Provide formal and informal training and support for Health Access Team Members on medical conditions, including treatments and evidence-based for treatment. Provide clinical consultation and support for Health Access ECM Team Members on physical health conditions, including evidence-based care. Represent the Enhanced Care Management team as the lead member when necessary. Develop interventions to improve the member’s ability to manage their own health. Support the clinical scope of responsibilities for non-clinically licensed care Team Members within the RN scope of practice. Cultivate and sustain productive partnerships with providers, team members, and community stakeholders. Employ advanced communication methods to strengthen collaboration across in-person, telephonic, and digital platforms. Model supportive and collaborative relationships with Members, co-workers, and community relations. Promote a collaborative and effective working environment within the Health Access Enhanced Care Management team by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as arise, and collaborating on Member case discussions. Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community. Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as identifying and addressing performance indicator measures, HEDIS gaps, and other quality measures. Participate in staff meetings, trainings, committee meetings, or other activities as needed or as directed by Leadership. Ensure documentation is accurate and in compliance with regulatory requirements and accreditation standards. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications: Education & Requirements Three (3) or more years of care management experience in a health care delivery setting required. Experience working successfully within a team, and experience in developing and maintaining effective relationships with both clients and coworkers is mandatory Experience in a Managed Care setting preferred Minimum of one (1) year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred Population of Focus Experience: Adults, unaccompanied youth & children, and families experiencing homelessness Adults, youth, and children who are at risk for avoidable hospital or ED care Adults, youth, and children with serious mental health and/or substance use disorder needs Adults living in the community and at risk for long-term care institutionalization Adult nursing facility residents transitioning to the community Children & youth enrolled in CCS or CCS Whole Child Model with additional needs beyond their CCS conditions Children & youth involved in child welfare (foster care) Adults & youth who are transitioning from incarceration Pregnant & postpartum individuals; birth equity population of focus Associate’s degree in Nursing from an accredited institution required Bachelor’s degree in Nursing from an accredited institution preferred Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required Certified Case Manager (CCM) preferred Key Qualifications Must have a valid California Driver’s license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points Strong knowledge and in-depth understanding of: Skill in evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies Understanding of and sensitivity to multi-cultural community Self-management philosophies and practices, especially as they relate to chronic medical conditions Awareness of the impact of unmitigated bias and judgement on health; commitment to addressing both Bilingual (English/ “Target Language”) preferred Highly skilled interpersonally, with excellent relationship skills Highly skilled in interpersonal communication, including resolving conflict with co-workers Skillful in informally and formally sharing expertise Must have skills to tolerate, manage and make effective use of a high level of ambiguity around new team models, new models of care, and new care management practices Start your journey towards a thriving future with IEHP and apply TODAY ! Work Model Location: Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Significant travel outside of the office to Providers offices, member’s homes, and out to the community. Must live within a 25-mile radius of the assigned service area and have reliable transport Pay Range: USD $91,249.60 - USD $120,910.40 /Yr.