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.
We currently have an opening for an After Hours Transfer Case Manager .
The goal of the Afterhours Transfer Case Manager is to effectively manage the patients during their hospitalization to assure the appropriate level of care is provided for the patient's current severity of illness, utilizing the appropriate tests and diagnostics, in the appropriate facilities in order to provide the highest level of care, in the most efficient manner, while utilizing only the resources necessary for that episode of care after normal business hours. The Afterhours Transfer Case Manager is also responsible for developing a safe discharge plan and implementing the discharge plan for patients with the necessary resources to ensure that care is provided without interruption along the continuum of care, whether in a skilled nursing facility, assisted living facility, in the home setting, etc. after normal business hours.The Afterhours Transfer Case Manager will plan, coordinate, and collaborate with internal departments to ensure the patient is receiving the best coordination of care. The Afterhours Transfer Case Manager will document based on regulatory and contractual guidelines established by Federal, State, Local and Health plan guidelines, along with policies and procedures established by the Medical Management department.
Essential Duties and Responsibilities include the following but are not limited to:
1.Perform clinical review upon admission and daily while patient is hospitalized
2.Assure appropriate level of inpatient care
3.Monitor inpatient stay to prevent delays in services and/or report aberrancy's.
4.Facilitate transfers from OON or OOA facilities to contracted facilities
5.Identify and resolve barriers or potential barriers to safe transition and outpatient management.
6.Coordinate and assure all services for care transitions including transfer to lower levels of care, transfer to outpatient management, etc.
7.Educate members on post discharge instructions, outpatient physician follow-up, appropriate use of urgent care, and appropriate use of ER services.
8.Initiate and hand off case to Skilled Nursing Case Managers or Outpatient Management Programs (i.e. Vital Care, TCM, Hospice, etc) as appropriate.
9.Timely response to member needs act in the moment.
10. Coordinate care for patients in the Emergency Room or Urgent Care to avoid an unnecessary acute inpatient admission.
11. Timely documentation based on regulatory and contractual guidelines established by Federal, State, Local and Health plan guidelines, along with policies and procedures established by the Medical Management department.
12. Creating and approving referrals for admissions and outpatient services based on Medical Management guidelines.
13. Creating letters for patients based on regulatory and contractual guidelines established by Federal, State, Local and Health plan guidelines, along with policies and procedures established by the Medical Management department.
14. Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
15. Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality care and concern with each and every internal and external customer.
16. Seek assistance and escalate issues when needed from the Administrator on call, or Regional Medical Director on call for clinical oversight and decision making.
17. Participate in Friday and weekend rounds with Regional Medical Director and Hospitalists.
18. Perform other duties as assigned.
Education and/or Experience:
1.Graduate from an accredited Registered Nursing Program or Licensed Vocational Nursing Program.
2.Current California Licenses
3.Knowledge of Healthcare and Managed Care preferred.
4.At least 2 years of clinical experience in the acute care setting.
5.Typing 40 words per minutes with accuracy.
6.Knowledge of computers, faxes, printers and all other equipment.
7.Knowledgeable in MS Office programs (i.e., Word, Excel, and Outlook).
8.Ability to deal with responsibility with confidential matters.
The hours for the Afterhours Transfer Case Manager will vary each week .
Monday to Friday hours are 7pm- 8am or 8pm -9am
Weekends hours are 8am-9p , 11am-12am or 8am-9am
We offer a full benefits package which includes employer paid medical, pharmacy and dental benefits. We offer a generous PTO package, 401k Retirement Savings, Life Insurance, Flexible Spending Account (FSA), Tuition Reimbursement & Licensed Renewal Fees for our clinical staff.
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.