The Case Manager is responsible for assessing, planning, and coordinating care for high-risk members to ensure their medical and psychosocial needs are met across the continuum of care. This role involves collaborating with physicians and healthcare teams to prevent hospital readmissions and facilitate effective transitions between care settings.
Requirements summary
Candidates must be graduates of an accredited Registered Nursing or Licensed Vocational Nursing program with a current California license. A minimum of 3 years of acute care or case management experience is required, along with proficiency in MS Office and accurate typing skills.
professional certificateCommunicationDocumentationTypingPatient educationMS Office proficiencyInterdisciplinary collaborationCase managementCare planningNursing standardsCommunity resource coordinationTransition of care managementClinical social assessmentPharmacological needs assessmentHospice conversion identificationPalliative care identificationFOCUS charting
Job description
Position Summary
The Vital Care Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified High Risk members. The Vital Care Case Manager will assess and develop a care plan in collaboration with the admitting, attending and consulting physician, the member and other health care practitioners. The goal of the Vital Care Case Manager is to effectively manage members on an outpatient basis to assure the appropriate level-of-care is provided, to prevent in patient admission and re-admissions, and ensure that the members’ medical, environmental, and psychosocial needs are met over the continuum of care.
Essential Duties and Responsibilities include the following
Keeps member/family members or other customers informed and requests if necessary, further assistance when needed.
Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
Functions as liaison between administration, members, physicians and other healthcare providers.
Interacts professionally with member/family/physicians and involves member/family/physicians in formation of the plan of care.
Performs a Clinical Social Assessment (CSA) of the member and determines an acuity score for necessary scheduled follow-up.
Develops an outcome-based plan of care, based on the member’s input and assessed member needs. Implements and evaluates the plan of care as often as needed as evidenced by documentation in the member’s case file.
Documents member assessment and reassessment, member care plans, and other pertinent information completed in the member’s medical record in accordance with the FOCUS Charting methodology, nursing standards, and company policies and procedures.
Initiates onsite hospital visits/rounds as needed to assess patient progress and meet with appropriate members of the patient care team.
Identifies planned and unplanned transitions of care from Requests for Services or daily inpatient and SNF census.
Educates the member/caregiver on the transition process and how to reduce unplanned transitions of care.
Manages transition of care from the sending to receiving settings ensuring that the Plan of Care moves with the member and updates/modifies the care plan as the member’s health care status changes.
Benefits
Employee Assistance Program
Dental insurance
Vision insurance
Flexible Spending Account
Medical insurance
Paid holidays
Tuition reimbursement
Life insurance
Mileage reimbursement
Vacation time
401k Retirement Savings Plan
Pharmacy insurance
Sick days
Income Protection Insurance
Behavioral Health Services
License renewal CEU reimbursement
Communicates appropriately and clearly with physicians, in patient case managers and Prior-Authorization nurses
Identifies and addresses psychosocial needs of the members and family and facilitates consultations with Social Worker, as necessary.
Identifies and addresses pharmacological needs of the members and facilitates consultations with the pharmacy department, as necessary.
Identifies community resources to address needs not covered by the member’s benefit plan, and coordinates member benefits as needed, with the health plan.
Participates in the efficient, effective and responsible use of resources such as medical supplies and equipment.
Responsible for the coordination and facilitation of member and family conferences as determined by assessment of member’s needs.
Identifies the appropriate members to participate in the interdisciplinary case round process. Prepares the necessary summary information to present to the team.
Responsible for the coordination of post-discharge clinic appointments, medication reconciliation, PCP and SPC visits.
Ability to collaborate and communicate with all members of the healthcare team (concurrent review, pre-authorization, PCP/SPC, Social Services, and Pharmacy) to coordinate the continuum of care of developing plans for management of each case.
Responsible for the identifying members that are appropriate for hospice conversion or Palliative care.
Meet with members/caregiver face to face in different locations (clinic, home, hospital, and community) in order to build a rapport with member so that the case manager can better support member/caregiver with care coordination and the plan of care.
All other duties as directed by management.
The pay range for this position at commencement of employment is expected to be between $37.50 - $40 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
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.
Full Time Position Benefits
The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness
Employer-paid comprehensive medical, pharmacy, and dental for employees
Vision insurance
Zero co-payments for employed physician office visits
Flexible Spending Account (FSA)
Employer-Paid Life Insurance
Employee Assistance Program (EAP)
Behavioral Health Services
Savings and Retirement
401k Retirement Savings Plan
Income Protection Insurance
Other Benefits
Vacation Time
Company celebrations
Employee Assistance Program
Employee Referral Bonus
Tuition Reimbursement
License Renewal CEU Cost Reimbursement Program
Business-casual working environment
Sick days
Paid holidays
Mileage
Qualifications
Education and / or Experience
Graduate from an accredited Registered Nursing Program or Licensed Vocational Nursing Program.
Current CA RN, or LVN license, current CPR certification, valid CA Driver’s license.
3 years acute care or case management experience.
2-3 years of utilization or HMO experience preferred.
Typing 40 words per minutes with accuracy.
Knowledge of computers, faxes, printers and all other office equipment.
Knowledgeable in MS Office Programs (i.e., Word, Excel, Outlook, Access and PowerPoint)
