Outpatient Case Manager

divh2Case Manager/h2pCase Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified High Risk members. The 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 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./ppKeeps member/family members or other customers informed and requests if necessary, further assistance when needed./ppDemonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner./ppFunctions as liaison between administration, members, physicians and other healthcare providers./ppInteracts professionally with member/family/physicians and involves member/family/physicians in formation of the plan of care./ppPerforms a Clinical Social Assessment (CSA) of the member and determines an acuity score for necessary scheduled follow-up./ppDevelops an outcome-based plan of care, based on the members input and assessed member needs. Implements and evaluates the plan of care as often as needed as evidenced by documentation in the members case file./ppDocuments member assessment and reassessment, member care plans, and other pertinent information completed in the members medical record in accordance with the FOCUS Charting methodology, nursing standards, and company policies and procedures./ppInitiates onsite hospital visits/rounds as needed to assess patient progress and meet with appropriate members of the patient care team./ppIdentifies planned and unplanned transitions of care from Requests for Services or daily inpatient and SNF census./ppEducates the member/caregiver on the transition process and how to reduce unplanned transitions of care./ppManages 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 members health care status changes./ppCommunicates appropriately and clearly with physicians, in patient case managers and Prior-Authorization nurses/ppIdentifies and addresses psychosocial needs of the members and family and facilitates consultations with Social Worker, as necessary./ppIdentifies and addresses pharmacological needs of the members and facilitates consultations with the pharmacy department, as necessary./ppIdentifies community resources to address needs not covered by the members benefit plan, and coordinates member benefits as needed, with the health plan./ppParticipates in the efficient, effective and responsible use of resources such as medical supplies and equipment./ppResponsible for the coordination and facilitation of member and family conferences as determined by assessment of members needs./ppPrepares the necessary summary information to present to the team./ppResponsible for the coordination of post-discharge clinic appointments, medication reconciliation, PCP and SPC visits./ppAbility to collaborate and communicate with all members of the healthcare team (concurrent review, pre-authorization, PCP/SPC, Social Services, Pharmacy) to coordinate the continuum of care of developing plans for management of each case./ppResponsible for the identifying members that are appropriate for hospice conversion or Palliative care./ppMeet 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./ppQualifications/ppGraduate from an accredited Registered Nursing Program/ppCurrent CA RN, current CPR certification, valid CA Drivers license./pp3 years acute care or case management experience./pp2-3 years of utilization or HMO experience preferred./ppTyping 40 words per minutes with accuracy./ppKnowledgeable in MS Office Programs (i.e., Word, Excel, Outlook, Access and PowerPoint)/ppOn call duties as assigned./ppJob Type: Full-time/ppRequired experience:/pulliEmergency Room: 1 year/liliAcute Care: 2 years/li/ulpRequired license or certification:/pulliRegistered Nurse (RN)/li/ulpCare Navigators On Demand is an Equal Opportunity Employer and does not discriminate on the basis of race or ethnicity, religion, sex, national origin, age, veteran disability or genetic information or any other reason prohibited by law in employment./p/div