Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.
Who Are We? ✨
Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.
Why Join Us? 🏆
We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
Job Summary
The role of the Case Manager is to promote quality, cost-effective outcomes for an assigned
population by facilitating collaboration and coordination across settings, assessing member
needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure
member's receive services and resources required to meet desired health and social outcomes.
The Case Manager ensures members progress toward desired outcomes with quality care that
is medically appropriate and cost-effective based on the severity of illness and the site of
service. The Case Manager is responsible for providing patient centered care across the care
continuum.
Functions & Job Responsibilities
• Assessment of the medical, social, and behavioral needs of an assigned population
• Completes comprehensive assessments of members per regulated timelines and
determines who may qualify for case management based on clinical judgment, changes
in member's health or psychosocial wellness, and triggers identified in the assessment.
• Develops and implements a case management plan in collaboration with the member,
caregiver, physician and/or other appropriate healthcare professionals and member's
support network to address the member needs and goals.
• Conducts telephonic, and face-to-face/virtual visits as required.
• Performs ongoing monitoring of the care plan to evaluate effectiveness of interventions
for goal achievement, suggest changes as needed and document updates accordingly.
• Maintains ongoing member caseload for regular outreach and management.
• Promotes integration of services for members including behavioral health care and longterm
services and supports/home and community to enhance the continuity of care for
Clever Care members.
• Uses motivational interviewing and Clever Care clinical guidelines to educate, support
and motivate change during member contacts.
• Assesses barriers to care, provides care coordination, and assistance to members to
address concerns.
• Additional duties, as assigned.
