The Outpatient Case Manager assesses, plans, and monitors care for high-risk members to ensure appropriate care levels and prevent unnecessary hospital admissions. This role acts as a liaison between patients, families, and healthcare providers while coordinating transitions of care and community resources.
Requirements summary
Candidates must be graduates of an accredited Registered Nursing program with a current California RN license and CPR certification. Preferred qualifications include 2-3 years of utilization or HMO experience and 3 years of acute care or case management experience.
professional certificateCommunicationDocumentationNursingCritical thinkingCare coordinationClinical assessmentPatient educationInterdisciplinary collaborationCase managementCare planningUtilization reviewMedication reconciliationMicrosoft officeTransition of careHMO experience
Job description
The Outpatient Case Manager is responsible for assessing, planning treatment, implementing interventions, monitoring, evaluating, and documenting outcomes for identified High-Risk members. The Outpatient Case Manager will assess and develop a care plan in collaboration with the admitting, attending, and consulting physicians, the member, and other health care practitioners. The goal of the Outpatient Care Manager is to effectively manage members on an outpatient basis to assure the appropriate level of care is provided, to prevent inpatient admission and re-admissions, and ensure that the members’ medical, environmental, and psychosocial needs are met over the continuum of care.
This role will support the DSNP Regulatory line of business, which serves high
risk dual members who require care coordination, transition of care support ,and on-going monitoring.
Essential Duties and Responsibilities include the following
Keeps member/family members or other customers informed and requests, if necessary, further assistance when needed.
Demonstrates the ability to follow through with requests, share critical information, and get back to individuals promptly.
Functions as liaison between administration, members, physicians, and other healthcare providers.
Interacts professionally with families/physicians and involves members/families/physicians in the formation of the plan of care.
Performs a Clinical Assessment/Questionnaire of the member and determines an acuity score for necessary scheduled follow-up.
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.
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.
Initiates community visits (hospital, home visits) as needed to assess patient progress and meet with appropriate members of the patient care team.
Identifies planned and unplanned transitions of care from Requests for Services or daily inpatient and SNF census.
Educates the member/caregiver on the transition process and how to reduce unplanned transitions of care.
Benefits
Dental insurance
Vision insurance
Medical insurance
Paid holidays
Tuition reimbursement
Life insurance
Mileage reimbursement
Vacation time
Employee assistance program
Flexible spending account
Pharmacy insurance
Sick days
401(k) retirement savings plan
Behavioral health services
Income protection insurance
License renewal ceu cost reimbursement
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.
Communicates appropriately and clearly with physicians, inpatient case managers, and Prior-Authorization nurses
Identifies and addresses the psychosocial needs of the members and family and facilitates consultations with the Social Worker, as necessary.
Identifies and addresses the pharmacological needs of the members and facilitates consultations with the pharmacy department, as necessary.
Identifies community resources to address needs not covered by the member’s benefit plan, and coordinates member benefits as needed, with the health plan.
Participates in the efficient, effective, and responsible use of resources such as medical supplies and equipment.
Responsible for the coordination and facilitation of member and family conferences as determined by assessment of the member’s needs.
Identifies the appropriate members to participate in the interdisciplinary case round process. Prepares the necessary summary information to present to the team.
Responsible for the coordination of clinic appointments, medication reconciliation, PCP, and SPC visits.
Ability to collaborate and communicate with all members of the healthcare team (concurrent review, pre-authorization, PCP/SPC, Social Services, and Pharmacy) to coordinate the continuum of care and develop plans for management of each case.
Responsible for identifying members who are appropriate for hospice conversion or Palliative care.
Meet with members/caregivers face-to-face in different locations (clinic, home, hospital, and community) in order to build a rapport with members so that the case manager can better support members/caregivers with care coordination and the plan of care.
Other duties as assigned by management.
The pay range for this position at commencement of employment is expected to be between for LVN's $35-40.00 per hour; RN's $45.00 - 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, the 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 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 succeFull-Timeimee 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
4401 (k)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.
Qualifications
Education and / or Experience
Graduate from an accredited Registered Nursing.
Current CA RN license and current CPR certification.
3 years acute care or case management experience preferred.
2-3 years of utilization or HMO experience preferred.
Knowledge of computers, faxes, printers and all other office equipment.
Typing 30 WPM with accuracy. Proficient in MS Office Programs (i.e., Word, Excel, Outlook, Access and PowerPoint).
