RN Case Manager - Value Based Service Organization
Overview
Full time RN leading care coordination at USC. Manage up to 100 commercial outpatients. Ensure cost effective quality outcomes. Lead interdisciplinary team and coordinate post hospital care. Differentiate by eliminating gaps and duplicate treatments.
What You'll Do50
- 1Document patient case management plans and ongoing activities
- 2Identify insurance coverage or other payment sources
- 3Assess patient risk factors and obstacles to care
- 4Connect patients to services and resources
- 5Communicate care preferences and advocate for patients
- 6Screen patients for healthcare needs
- 7Develop patient focused case management plans
- 8Educate families on case management process
- 9Concurrently review patients for appropriate status assignment
- 10Complete InterQual or MCG reviews within 24 hours of admission
- 11Care manage observation patients daily
- 12Facilitate throughput and timely discharges
- 13Manage case load up to 100 commercial outpatients
- 14Utilize online work list to manage daily caseload
- 15Assess physical and biopsychosocial needs using multiple data sources
- 16Analyze and interpret data with patient and team
- 17Ensure specific care plans are in place for all patients
- 18Schedule appointments and arrange transportation
- 19Participate in interdisciplinary meetings and team huddles
- 20Answer provider and patient calls regarding request status
- 21Assess discharge planning needs and document in system
- 22Collaborate with social workers for psychosocial needs
- 23Work with care team on financial issue identification
- 24Educate healthcare team on best practices
- 25Represent department professionally
- 26Assist with new staff orientation
- 27Delegate supervision of Ambulatory Care Management Coordinators
- 28Make appropriate referrals to supervisor or Medical Director
- 29Participate in guideline competency testing
- 30Participate in HEDIS measure processes
- 31Adhere to program policies and procedures
- 32Respect patient/family values and respond promptly
- 33Support patient/family with end of life issues
- 34Include patients in care decisions and planning
- 35Assist with patient education needs for discharge
- 36Inform patients of discharge plans
- 37Work with transitions of care process
- 38Propose alternative treatment options for cost efficiency
- 39Identify and create solutions to remove care barriers
- 40Complete case management care plans to prevent ER visits
- 41Maintain awareness of managed care contract requirements
- 42Coordinate inpatient activities including concurrent and retrospective reviews
- 43Perform InterQual and MCG assessments upon admission, change in level of care, every two days, and discharge
- 44Participate in InterQual and MCG competency testing
- 45Perform initial/concurrent reviews on identified inpatients
- 46Direct pertinent clinical information to contracted inpatients
- 47Collaborate with Medical Director on complex cases
- 48Complete clinical reviews and plans of care timely
- 49Prioritize clinical reviews, caseloads, census loads, and assignments
- 50Other duties as requested
Requirements12
- 1Associate’s Degree in Nursing
- 25 years clinical experience
- 32 years ambulatory case management or utilization review experience within last three years
- 4Ability to work independently with minimal supervision
- 5Process oriented
- 6Good computer skills
- 7Bachelor’s Degree in Nursing preferred
- 8Knowledge of CM standards, UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, InterQual guidelines, Medicaid/Medicare contracts
- 9Fire Life Safety Training (LA City)
- 10Basic Life Support certification
- 11Registered Nurse license CA DCA
- 12Requirement to obtain card within 30 days of hire in LA City
Salary Insight
$110 - $181k per year
Location
Required Skills
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