Job description

Under the direction of the Supervisor, the RN Nurse Case Manager will assess, diagnose, plan, implement, and evaluate the patient to facilitate and coordinate the patient’s plan of care with the provider. The Case Manager will help determine when patients are stable for discharge from Priority Care back to their home (i.e. residence, Assisted Living Facility, LTC placement) with medical follow-up by a physician. The case manager in addition may be given members to be assessed and managed in the SNP Program (Special Needs Population).

• Maintain patient confidentiality.
• Be flexible and adaptable.
• Obtain and document all pertinent patient information and notes in NextGen.
• Strive for positive and professional relationship with providers, patients, and families.
• Provide effective communication with various health care providers, including specialists.
• Attend all scheduled patient office visits and execute provider orders in a timely manner.
• Evaluate patient’s level of acuity based on the clinical criteria and update level with changes in patient health status.Level 1A – 99100 – HIGH acuity – Weekly Case Manager follow up – End Stage health conditions, severe, acute and/or chronic health concerns.

Level 1B – 99101 – MODERATE acuity – Bi-Weekly Case Manager follow up – multiple co-morbidities, acute and chronic health concerns, recent hospitalizations.
Level 2A – 99102 – LOW acuity – Monthly Case Manager follow up – stable, needs minimal follow up, conditions well controlled, near return to PCP.

• Complete annual intake assessment with RN’s reviewing LVN documentation.Including patient’s self-management plan, goals, barriers, and progress toward goals, caregiver resources, psychosocial assessment, DME, mental health status, medical status, medication review, etc.
• Create a comprehensive and working care plan following NCQA, CMS, & Health Plan guidelines, with input from the IDCT and patient or caregiver.
• Incorporate the completed HRA, provided by the Health Plan, into the care plan.
• Set and prioritize appropriate patient centered goals.
• Update care plans with changes in patient’s medical status.
• Be knowledgeable regarding disease processes and medications to ensure the ability to assess patient needs and provide education as indicated.
• Ensure the patient progresses through the continuum of care by coordinating the integration of social services, case management, patient care needs, and home planning processes.
• Coordinates the provision of Social Services and/or Patient Services Coordinator to patients and families to enable them to cope with the impact of illness on individual family functioning and to achieve maximum benefits from healthcare services.
• Mobilizes resources and intervenes, as needed to achieve expected goals to assist in achieving desired clinical outcomes within the desired timeframe.
• Ensure patient tests are appropriate and necessary and are carried out within the established timeframe and that the results are promptly available.
• Ability to be proactive with treatment options.
• Aggressively assist in information gathering to allow for insightful decisions.
• Strive for timely admissions and discharges from Priority Care Clinic.
• Ensure a smooth transition of care back to Primary Care Provider after discharge from Priority
• Initiate/participate in Code Red, Code White and Code Blue situations as directed.
• Requires familiarity with the clinical structure of BFMC and the health care services with which it
• Understand patient healthcare benefits and help establish expectations for services within those benefit limits.
• Establish and maintain a functional familiarity with all contract services with which we deal.
• Be familiar with all policies, procedures and documentation related to the SNP Program.
• Ensure reporting (annually and/or transitions of care) for SNP patients in IDT Meetings.
• Educate and assist in decisions regarding end of life care including Advance Directive Forms, Durable Power of Attorney, POLST Forms, etc.
• Facilitate any Transitional Care needs and ensure follow-through on all discharge orders.
• Participate in the Utilization Review process regarding any assigned patients ensuring proper hand off report to U.R. Case Manager.
• Attend Utilization Review meetings as directed.

Qualifications:

• Graduate from an accredited Registered Nursing program.
• Current California RN license.
• Current BLS certification.

Job Type: Full-time

Pay: $48.60 - $57.18 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Free parking
• Gym membership
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

License/Certification:

• RN License (Preferred)

Work Location: In person

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