Outpatient Case Manager (RN/LVN) UHM-3755 {{jcity}}{{jstate}} Nursing Position Type: Full-time Position Summary: The Outpatient Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation, and documentation on identified High Risk members. The Outpatient 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 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. Essential Duties and Responsibilities include the following: Keeps member/family members or other customers informed and requests further assistance when needed. Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner. Functions as a liaison between administration, members, physicians, and other healthcare providers. Interacts professionally with member/family/physicians and involves them 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 needs. Implements and evaluates the plan of care as needed, as evidenced by documentation in the member’s case file. Documents member assessments and reassessments, member care plans, and other pertinent information 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. 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 psychosocial needs of the members and family and facilitates consultations with Social Workers, as necessary. Identifies and addresses 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 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 to coordinate the continuum of care of developing plans for management of each case. Responsible for identifying members that are appropriate for hospice conversion or Palliative care. Meet with members/caregiver face to face in different locations (clinic, home, hospital, and community) in order to build rapport with members so that the case manager can better support them with care coordination and the plan of care. All other duties as directed by management. The pay range for this position at commencement of employment is expected to be between LVN's $37.50 - $40 per hour or for RN's $45 - $50 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. If hired, 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. 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. Requirements Education and / or Experience: Graduate from an accredited Registered Nursing Program or Licensed Vocational Nursing Program. Current CA RN or LVN license, current CPR certification, valid CA Driver’s license. 3 years acute care or case management experience preferred. 2-3 years of utilization or HMO experience preferred. Typing 40 words per minute with accuracy. Must have valid CA DL and provide proof of vehicle insurance. Knowledge of computers, faxes, printers, and all other office equipment. Knowledgeable in MS Office Programs (i.e., Word, Excel, Outlook, Access, and PowerPoint). J-18808-Ljbffr