The Case Manager assesses, plans, intervenes, monitors, and documents patient care during acute episodes, focusing on facilitating timely transfers for Medi-Cal members into capitated hospitals. They manage hospitalization to ensure the right level of care and coordinate safe discharges with necessary post-acute resources, including a 24-hour follow-up call.
Requirements summary
Candidates must be a graduate of an accredited RN Nursing Program and hold a current California License, along with typing proficiency of 40 words per minute. Knowledge of Healthcare and Managed Care is preferred, as is familiarity with standard computer equipment and MS Office programs.
The Inpatient Transfer Team Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode.
Assesses and develops a care plan in collaboration with the admitting, attending and consultant physicians, and other healthcare practitioners.
The goal of the Inpatient Transfer Case Manager is to effectively identify which Medi-Cal members need to be transferred from a non-capitated hospital and work in collaboration with the hospitalist(s), Medical Director(s), hospital staff to facilitate timely transfer into the campus capitated hospital.
The Inpatient Transfer Case Manager is to manage the patients during their hospitalization to assure the right level of care is provided for the patient’s current severity of illness, utilizing the appropriate tests and diagnostics, in the appropriate facilities in order to provide the highest level of care, in the most efficient manner, while utilizing only the resources necessary for that episode of care.
The Inpatient Transfer Case Manager is also responsible for the safe discharge of patients with the necessary resources to insure that care is provided without interruption along the continuum of care, that is, whether in a skilled nursing facility, assisted living facility or in the home setting.
Such discharge will be planned and coordinated in collaboration with the Vital Care Case Manager for patients enrolled in the Vital Care program.
The Inpatient Transfer Case Manager will document the discharge plan, together with the current medication list, and scheduled follow-up appointments in the authorization notes and will communicate the same to the Vital Care Case Manager, the patient, and family members concerned.
A follow-up post-discharge call will be made by the Inpatient Transfer Case Manager or the department’s designee within 24 hours of discharge to determine any problems, issues, or risks encountered in the transition.
Essential Duties and Responsibilities include the following
Anticipates our customer needs: Understands the wants and needs of customers, listens for cues and identifies how to respond and at the appropriate level of intervention needed.
Surveys the customer’s environment and takes appropriate action.
Refrains from discussing personal business in front of the customer or speaking a foreign language different from the customer’s language.
Greets patients, family members, visitors, and physicians in a positive manner by introducing self, speaking clearly and with confidence.
Returns phone calls to customers and follows up with requests.
Keeps patient/family member or other customer informed and requests if further assistance is needed.
Assists others and supports the team.
Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
Demonstrates honesty and integrity in everyday activities.
Recognizes when an error is made and reports them appropriately.
Protects privacy for both patients and employees; ensures information sensitive papers, charts, and reports are not in view of the public.
Recognizes when an error has been made and immediately reports to appropriate manager.
Participates in “service recovery” through follow-up with the injured party, gathering information, and demonstrates empathy.
Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families. Functions as liaison between administration, patients, physicians, and other healthcare providers.
Interacts professionally with patient/family/physicians and involves patient/family/physicians in the formation of the plan of care.
Communicates appropriately and clearly to management, co-workers, and physicians.
Identifies and addresses psychosocial needs of the patients and family and facilitates consultations with a Social Worker, as necessary.
Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate.
Communicates using age appropriate language.
Understands and applies principles of adult learning methods as they relate to health care educational needs.
Receives and reviews physician’s orders; documents completion. Follows through to ensure orders are carried out.
Consults other departments as appropriate to provide for an interdisciplinary approach to the patient’s needs.
Formulates an outcome-based plan or care, based on assessed patient needs, implements and evaluates plan as evidenced by documentation.
Maintains quality monitors as assigned by Supervisor.
Participates in orientation, instruction/training of new personnel.
Pursues additional education (in-services, seminars, self-study, and formal education programs) to advance nursing skills and knowledge.
Documents patient assessment and reassessment, patient care plans and other pertinent information completely, in the patient’s medical record according to nursing standards and policies.
Assures complete and proper charging of supplies.
Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.
Completes daily documentation, required letters, and referrals in a timely manner.
All other duties as directed by management.
The pay range for this position at commencement of employment is expected to be between LVN $37.50 - $40 per hour or for RN $45 - $50; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
Qualifications
Education and/or Experience
1.
Graduate from an accredited RN Nursing Program.
2.
Current California Licenses 3.
Knowledge of Healthcare and Managed Care preferred.
4.
Typing 40 words per minutes with accuracy.
5.
Knowledge of computers, faxes, printers and all other equipment.
6.
Knowledgeable in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point).
7.
Ability to deal with responsibility with confidential matters.
