Works collaboratively with an assigned panel of physicians to manage the patients specialized needs. The managing team does differ according to the chronic disease. Duties include assessment to identify member needs and development of specific care management plan to address needs. In conjunction with the Physician, implements care/treatment plan by coordinating access to health services across multiple providers/ disciplines, monitors care, makes determination to arrange transportation and tran... more details
Description:
Job Summary:
Works collaboratively with an assigned panel of physicians to manage the patients specialized needs. The managing team does differ according to the chronic disease. Duties include assessment to identify member needs and development of specific care management plan to address needs. In conjunction with the Physician, implements care/treatment plan by coordinating access to health services across multiple providers/ disciplines, monitors care, makes determination to arrange transportation and transfer patient if indicated, identifies cost-effective measures, makes recommendations for alternative levels of care and utilization of resources, promotes self-care management and ensures paper work is completed. Is an indirect caregiver. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team.
Essential Responsibilities:
Evaluates and identifies members needs. Interfaces with Primary Care Physicians, Specialists and various disciplines on the development of case management plans/programs.
Monitors and evaluates the effectiveness of the case management plans and modifies as necessary.
Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families.
Acts as a clinical liaison, per their specialty, with outside agencies such as County CCS, non-plan facilities, outside providers, employers and/or workers compensation carriers and third party administrators.
Prepares reports, communicates program changes to appropriate staff and develops protocols in accordance with state regulations.
Acts as a patient advocate and educator to assure that the patient has the knowledge to care for his/her condition and patient is educated and empowered to be responsible for participating in the plan of care.
Develops individualized patient/family education plan focused on self-management, delivers patient/family education specific to a disease state.
Develops and updates training and educational materials and presents to appropriate staff, members and families. Facilitates patients return to normal daily activities by teaching and making appropriate referrals for outside services/continued care.
Consults with internal and external physicians, health care providers, discharge planners, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
May need to facilitate transportation and housing arrangements for patient. Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
Participates in data collection and analysis of clinical outcomes of care and customer satisfaction standards. Participates in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service. Ensures that accurate records are maintained of the care associated with each patient.
Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers and outside agencies.
Basic Qualifications:
Experience
Minimum two (2) years clinical experience as an RN in an acute care or ambulatory care setting required.
Education
Bachelors degree or equivalent experience four (4) years required.
For positions in High Risk Infant Program: Bachelors degree in nursing or related field required.
License, Certification, Registration
Registered Nurse License (California)
Basic Life Support
Additional Requirements:
Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of utilization review/management, care coordination, transfer coordination, discharge planning or case management.
Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking and problem-solving skills required.
Computer literacy skills required.
Cancer Program: OCN required within one (1) year of hire.
High Risk Infant Program: Meet requirements to be a CCS paneled provider.
Regional Genetic Screening Program: BLS is not required.
Preferred Qualifications:
Cancer Program: Two (2) years experience in Ambulatory Oncology.
Total Joint Replacement Travel Surgery Program (OC): One (1) year experience in Total Joint Replacement.
Case Management Certification or certification in the area of specialty preferred.
Bachelors degree in nursing or healthcare related field preferred.
For positions in High Risk Infant Program: Masters degree and PHN preferred.
Notes:
Will provide patient care coordination for SCAL patients including San Diego region.
Job Abstracts is an independent Job Search Engine. Job Abstracts is not an agent or representative and is not endorsed, sponsored or affiliated with any employer. Job Abstracts uses proprietary technology to keep the availability and accuracy of its job listings and their details. All trademarks, service marks, logos, domain names, and job descriptions are the property of their respective holder. Job Abstracts does not have its members apply for a job on the jobabstracts.com website. Additionally, Job Abstracts may provide a list of third-party job listings that may not be affiliated with any employer. Please make sure you understand and agree to the website's Terms & Conditions and Privacy Policies you are applying on as they may differ from ours and are not in our control.
We would like to take a second to Welcome You to Job Abstracts, the nation’s largest Pure Job Board. With over 3.1 million job listings from 15,000+ Companies & Organizations, we help job searchers find careers that match their interests. As an anonymous user, you have probably discovered how easy our system is to use. However, you have just scratched the surface of what we can offer.
We encourage you to Register so you can use our most powerful features: searching with multiple terms, setting up multiple locations, establishing favorite companies, and accessing your search history. If you find a job you like, you can apply directly for it, and then, keep notes on it. We will also keep a lookout for jobs that match your search terms and email you when we find something you may like.
You can register for free and the system is free to use. If you like our system so far, click on Register and unlock the power required by serious job searchers.
Any time you conduct a search, the system shows you job matches, ranked by their Relevance Score (RS).
The score is calculated by a proprietary algorithm that uses Intelligent Machine Learning.
The Relevance Score tells you how well the job opportunity matches your search term or terms.
When not logged in, the system is limited to one search term. Scores for single term matches are usually lower.
When you register, log in, and set up multiple terms prioritized by importance, the jobs found for you will receive a much higher Relevance Score.
