Outpatient Case Manager, RN/LVN
Company: Lakeside Medical
Posted on: May 3, 2021
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 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 in
patient admission and re-admissions, and ensure that the members'
medical, environmental, and psychosocial needs are met over the
continuum of care.
Keeps member/family members or other customers informed and
requests if necessary, 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 liaison between administration, members, physicians
and other healthcare providers.
Interacts professionally with member/family/physicians and
involves member/family/physicians in formation of the plan of
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.
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
Communicates appropriately and clearly with physicians, in
patient case managers and Prior-Authorization nurses
Identifies and addresses psychosocial needs of the members and
family and facilitates consultations with Social Worker, as
Identifies and addresses pharmacological needs of the members
and facilitates consultations with the pharmacy department, as
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
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, Pharmacy) to coordinate the continuum of care of
developing plans for management of each case.
Responsible for the 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 a rapport
with member so that the case manager can better support
member/caregiver with care coordination and the plan of care.
- Other duties as assigned.
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 minutes with accuracy.
Must have valid CA DL and provide proof of vehicle
Knowledge of computers, faxes, printers and all other office
Knowledgeable in MS Office Programs (i.e., Word, Excel, Outlook,
Access and PowerPoint)
- Optional on call 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.
Keywords: Lakeside Medical, Covina , Outpatient Case Manager, RN/LVN, Other , Covina, California
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