RN Chronic Care Manager - Full Time, Days (Hybrid-Culver City)

Position Summary

The CRC Chronic Care Manager for Population Health and Value Based Care will facilitate coordination, communication, and collaboration with patients/members, providers, ancillary services, and leadership to achieve goals and maximize patient/member outcomes through an innovative whole person chronic care strategy by working with CRC, Hospitals, MSOs and IPAs. Best practice focus will be placed on the provision of care in the ambulatory care settings, efficient patient/member management through chronic care management and leadership escalation to ensure appropriate use, level of care and timeliness of services. The Chronic Care Manager for Population Health and Value Based Care will promote the vision and be responsible for the implementation of these strategic objectives.

Required Qualifications

• Unencumbered California Registered Nurse (RN), bachelor's degree.
• Current Licensure as a CA Registered Nurse required. Board Certified Nurse Practitioner (NP-BC) preferred.
• AHA Basic Life Support.
• AHA Advanced Cardiac Life Support
  
• The Chronic Care Nurse Care Manager is responsible for the successful performance improvement of the health of patients/members under managed care agreements. Must have excellent verbal and written communication skills with fast paced problem-solving skills and the confidence to quickly implement resolutions. Chronic Care Nurse Care Manager will be required to have skills to independently utilize software such as Outlook, Word, Visio, Power Point, and Excel, as well as electronic health record documentation (i.e. Allscripts).
• Seeking Chronic Care Nurse Care Manager with experience utilizing screening tools (i.e. MCG and InterQual). Experience in operationalizing and executing a Care Management Plan, hold a keen understanding of Daily Discharge Multi-Disciplinary Meetings, or other like management tools. Must hold experience with Care and Population, Data and EMR Systems (i.e. Allscripts Care Management). Knowledge of DRG, value based, risk based (capitation) and per diem payment methodologies.
• Must hold knowledge of all Federal, State and Local regulatory standards, have working level knowledge of healthcare systems and applications to be able to successfully plan and coordinate activities and serve as a key resource to staff and others across the organization. The Chronic Care Nurse Care Manager must have excellent written and verbal communication skills in English and be confident presenting to all levels of the organization. Previous experience across multiple healthcare settings (in-patient acute care, ambulatory, and long-term care) preferred.
  

• Bachelor of Nursing (BSN) or higher preferred .

• T wo (2) years of experience in an acute care role, with at least one (1) year in a care management role preferred. Chronic Care Nurse Care Manager with care management leadership and/or medical group/MSO care management experience (i.e. complex member management, and/or population health role) preferred.

Essential Job Functions / Major Areas of Responsibility

The essential functions below are not intended to be an exhaustive list of all duties that may be assigned to this position, nor does it restrict the duties which may be assigned to this position if such duties reasonably relate to the position.

• The Chronic Care Manager for Population Health and Value Based Care will have responsibility for these complex care management functions:
  • Ambulatory Case Management – Complex and High Intensity
  • Disease Management Programs
  • Complex Care Services Performance Improvement Program (CCSPIP)
  • Initial and On-Going Chronic Care Planning
  • Subject Matter Expert (SME) for CalAIM initiative
  • Content development, professional expertise and/or care provision for Medicaid and Medicare members

• In partnership with the Director, the Chronic Care Manager for Population Health and Value Based Care ensures the aforementioned programs are a collaborative process of identification, assessment, planning, intervention, coordination and evaluations and as appropriate: integrates the participation of all those involved in the care of the member, including the primary care physician, medical and surgical specialists, nurses, behavioral and mental health specialists, physical, occupational, and speech therapists, social workers, allied health professionals, and community-based providers. On an ongoing basis, the Chronic Care Manager for Population Health and Value Based Care assures the following goals are achieved, including, but not limited to:
  • Proactively identifying members with serious and complex conditions
  • Screening and identifying appropriate patients for the CCSPIP
  • Maximizing members optimal functioning, management of their chronic conditions, and working to enhance the member's independent living capabilities in concert with the Medical Director, Director of Population Health and Care Management, Social Worker(s) and CTC/CHW
  • Facilitating the continuity and coordination between providers, facilities, community resources and the health plan
  • Facilitating interdisciplinary communication, care planning, and member compliance with the physician's treatment regimen
  • Enhancing member satisfaction with Prospect's health care delivery system
  • Coordinating member's eligible benefit coverage to best serve their medical conditions and social needs
  • Utilizing creative solutions to assist in-patient care managers with complex vulnerable and underserved patients who are difficult to place upon discharge; through the coordination of cost-effective alternatives, especially as they relate to CalAIM
  • Developing an individualized, comprehensive, multidisciplinary care plan that best meets the member's medical and psychosocial needs and
  • Providing consistently positive, constructive interface with internal departments and physicians as needed

Physical Requirements

Indicate physical requirements for performing the essential functions of the job by double clicking and selecting 'checked' on the boxes below. These are requirements normally expected to perform regular job duties. Reasonable accommodations may be made in compliance with the Americans with Disabilities Act of 1990, and applicable, state and local law, to enable individuals with disabilities to perform the essential functions. Incumbent must be able to successfully perform all of the essential functions of the job with or without reasonable accommodation.

Pay rate: Min - $60.18 l Max - $75.23

Job Listing ID: 1791975