(RN) Lead, SNF Case Manager

Position Summary:

Under the direction of Director, Social Services and collaborating closely with Case Management Teams, the Advance Care Planning (ACP) Case Manager is responsible for assisting in the successful implementation of Advance Care Planning (ACP) Management Program in the North Region. This program is designed to establish early identification and focused care coordination of eligible/potentially eligible members requiring end of life planning and facilitate appropriate services for the member.

The primary goal of the Advance Care Planning (ACP) CM is to effectively identify hospice/palliative appropriate members on an inpatient/outpatient basis to assure that these members are transitioned to palliative/hospice care by working in partnership with our contracted hospice companies wherever possible. To this end, the Advance Care Planning CM will offer professional facilitation to our eligible and potentially eligible members to assist them in developing and articulating their wishes regarding their end of life issues, including palliative/hospice care.

Further, the Advance Care Planning CM will Provide assistance to members and their families in the form of end of life planning guidance and resource referrals.

Essential Duties And Responsibilities include the following:

• Identifies hospice appropriate members through Advance Care Planning consultations and work to enroll those members onto hospice/palliative care as appropriate.
• Receives referrals from: TCM members for possible hospice/palliative care needs, Outpatient CM's, PCP's/CQC Meetings or administrators from medical group operations, Social Workers and Medical Directors/Administrators/Clinical Project Managers.
• Review the daily Inpatient and discharge reports to determine appropriate candidates for hospice/palliative care.
• Collaborates with Clinical Liaison from Valley's Best to identify eligible palliative/hospice Members from Disease and Life Planning Registry.
• Attends and Participates in ICT meetings, PCP/CQC meetings, or administrative conferences, inpatient rounds and social worker referrals that involve potential hospice/palliative care referrals, as requested/needed.
• Interacts professionally with member/family/physicians and involves member/family/physicians pertaining to ACP activities.
• Consults with social workers/case managers to facilitate in-services, and works with VBH to coordinate frequent staff in services, onboarding SW/CMs and provided training with staff model clinics.
• Visits with clinics to build relationships with providers.
• Conducts ACP consults/visits with patients in the hospital, community, home, provider clinic to facilitate palliative/hospice transition.
• Visits patients in the hospital, community, home, provider clinic to facilitate palliative/hospice transition.
• Visits hospitals for end of life discussions/hospice transitions if in agreement with hospitalist and RMD and if needs are not psychosocial (otherwise SW to attend and joint visit with SW performed)
• Completes telephonic consultations with member/family about end of life planning as necessary.
• Reviews all North hospice discharges in real time (revocations/discharges for extended prognosis) for possible re-conversions to hospice/palliative care (Not to take over case management for post hospice discharge needs).
• Reviews hospice authorizations (clinical) to determine if member is hospice/continues to be hospice appropriate and provider has the appropriate LOC based on medical record submission.
• Conducts clinical discussions with hospice provider as needed to ensure members continue to be appropriate and are receiving the appropriate LOC.
• Collaborates with assigned Case Manager/Physician for members that are not palliative/hospice appropriate or do not convert to Palliative/Hospice Care; or be able to outsource to Social worker or other resources as appropriate to meet member's specific needs.
• Works on special project proposals to increase hospice/palliative referrals and enrollments.
• Provides education on hospice, advance healthcare directives, and POLST.
• Assists in educational endeavors of department.
• Assists with chart auditing and maintain quality monitors as assigned by Manager
• Participates in orientation, instruction/training of new personnel.
• Pursues additional education (in-services, seminars, self-study, and formal education programs) to advance skills and knowledge.
• Documents appropriately pertinent information completely, in the electronic medical documentation system.
• Prepares reports and compiles statistical data regarding members, as determined by the management team.
• Protects privacy for both members and employees; ensuring all personal health information is kept confidential and comply with HIPPA regulations.
• Other duties as directed by management.

Organizational Responsibilities:

• Proactively support and practice company mission, vision and values.
• Follow Employee Handbook guidelines and company policies and procedures.
• Follow established departmental dress code.
• Appropriately and accurately maintain time keeping records.
• Adhere to attendance policy and time off requests.
• Follow safety policies and procedures.
• Be flexible and adaptable and courteous and promote professionalism.
• Communicate verbally and in writing through appropriate channels.
• Maintain confidentiality at all times in compliance with company policy and HIPAA requirements.
• Employee has completed all required annual Compliance training and signed attestation form is attached for each module.

The pay range for this position at commencement of employment is expected to be between $45 $50.00 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

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.

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.
• 2 years hospice experience required (must have knowledge of hospice LCD).
• 3 years acute care or case management experience.
• Reside in close proximity to the LA Campus enrollees.
• 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
• Bilingual skill (Spanish) preferred.
• Knowledge of Medi-Cal, HMO, Medicare and Cal Medi-Connect covered services.
• Ability to work with all levels of management.
• Must have excellent communications skills both verbally and written.
• Must have excellent organizational skills.
• Required to travel for member appointments.
• Must have experience working with a diverse member population, primarily consisting of senior members.
• Must have ability to work effectively as a liaison with stakeholders.
• Must have team-based management and leadership skills.
• Must have ability to work independently and prioritize work.