Ucmg Case Manager, Lvn/ RN

Lakeside Medical Orange , CA 92856

Posted 2 weeks ago

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.

The Case 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.
1.Keeps member/family members or other customers informed and requests if necessary, further assistance when needed.
2.Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
3.Functions as liaison between administration, members, physicians and other healthcare providers.
4.Interacts professionally with member/family/physicians and involves member/family/physicians in formation of the plan of care.
5.Performs a Clinical Social Assessment (CSA) of the member and determines an acuity score for necessary scheduled follow-up.
6.Develops an outcome-based plan of care, based on the member's input and assessed member needs. Implements and evaluates the plan of care as often as needed as evidenced by documentation in the member's case file.
7.Documents member assessment and reassessment, member care plans, and other pertinent information completed in the member's medical record in accordance with the FOCUS Charting methodology, nursing standards, and company policies and procedures.
8.Initiates onsite hospital visits/rounds as needed to assess patient progress and meet with appropriate members of the patient care team.
9.Identifies planned and unplanned transitions of care from Requests for Services or daily inpatient and SNF census.
10. Educates the member/caregiver on the transition process and how to reduce unplanned transitions of care.
11. Manages 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 member's health care status changes.
12. Communicates appropriately and clearly with physicians, in patient case managers and Prior-Authorization nurses
13. Identifies and addresses psychosocial needs of the members and family and facilitates consultations with Social Worker, as necessary.
14. Identifies and addresses pharmacological needs of the members and facilitates consultations with the pharmacy department, as necessary.
15. Identifies community resources to address needs not covered by the member's benefit plan, and coordinates member benefits as needed, with the health plan.
16. Participates in the efficient, effective and responsible use of resources such as medical supplies and equipment.
17. Responsible for the coordination and facilitation of member and family conferences as determined by assessment of member's needs.
18. Identifies the appropriate members to participate in the interdisciplinary case round process. Prepares the necessary summary information to present to the team.
19. Responsible for the coordination of post-discharge clinic appointments, medication reconciliation, PCP and SPC visits.
20. Ability 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.
21. Responsible for the identifying members that are appropriate for hospice conversion or Palliative care.
22. Meet 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.
23. Other duties as assigned.

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



icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Specialty Case Manager

Western Dental

Posted 4 days ago

VIEW JOBS 4/21/2019 12:00:00 AM 2019-07-20T00:00 In collaboration with Quality Management and Specialty Ops, developing, monitoring and evaluating patient treatment plan progress and facilitating coordination of scheduling and communication. The Specialty Case Manager reports to the Vice President of Quality Management and the Senior Vice President of Specialty. Responsibilities: * Case intake * Efficient tracking and management of open and closed cases * Manage day to day communication and coordination between patient, specialist, dental office management, specialty scheduler and other necessary individuals assisting with the coordination of care of the patient * Prepare and present monthly reports outlining the disposition of cases Requirements Requirements: * Bachelor's degree or equivalent combination of education and experience * Minimum of five years dental or medical experience * Minimum of two-year role where patient care and problem resolution was a focus * Excellent verbal and written communication * Intermediate to advanced use of Microsoft Office (Excel and Word) * Able to work in a fast paced highly regulated environment and meet applicable daily, weekly, quarterly and annual deadlines and requirements * Complex problem solving and ability to identify opportunities, including process improvement * Strong time management skills * Ability to demonstrate high level of patient care, listening skills, empathy and advocate on the patient's behalf * Ability to interface with a wide variety of disciplines and personalities * Bilingual Spanish is a plus To apply please email: mclement@westerndental.com Western Dental Orange CA

Ucmg Case Manager, Lvn/ RN

Lakeside Medical