Job Summary
We are seeking a dedicated and compassionate Case Manager to join our team. As a Case Manager, you will be responsible for coordinating and overseeing the care of patients, ensuring they receive the appropriate medical services and resources.

Responsibilities

• Maintain ongoing communication with the members and ensure coordination of care between member and all providers
• Work in collaboration with the respective medical directors, Prior Auth team, and inpatient team to discuss member candidacy, clinical eligibility, and medical stability
• 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 care.
• 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.
• Educates the member/caregiver on the transition process and how to reduce unplanned transitions of care.
• Communicates appropriately and clearly with physicians, in patient Case Managers and Prior-Authorization nurses
• Responsible for the coordination and facilitation of member and family conferences as determined by assessment of member’s needs.
• Identifies and addresses psychosocial needs of the members and family and facilitates consultations with Social Worker, as necessary.
• Ability to collaborate and communicate with all members of the healthcare team (concurrent review, pre-authorization, PCP/SPC, Social Services) 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.
• Log member’s activity and send a summary report to the committee on a monthly basis.
• All other duties directed by management.
• Prior Authorizations team to enter and approve an Outpatient Case Management authorization. Transplant Case Manager and Manager of High Risk Programs to be sent an email as an additional notification of a new member pending assessment
• Transplant Case Manager may be referred a case as identified by Case Managers

Once a member has been referred into case management, the Transplant Case Manager has 72 hours to initiate initial contact with the member

• Transplant CM to ensure that coordinator has requested any pertinent clinical notes for review. Examples: pertinent labs, recent clinical notes.
• Transplant CM to review all clinical information obtained and document a summary of review
• Transplant CM to review all authorizations and document a summary of review
• Diagnoses noted
• Pertinent social history
• History of hospitalizations

Requirements:

• LVN / RN with a valid CA Nurse License.
• Recent acute care experience / strong clinical background and case management experience.
• Prior transplant case management experience desirable.
• Keyboard skills, familiar with Microsoft Word/Office/Outlook.
• Familiar with coding (CPT/HCPC/ICD-10).

The pay range for this position at commencement of employment is expected to be between $38.00 - $40.00 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, 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 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.

Full Time 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:

• 401k 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

Job Type: Full-time

Pay: $36.00 - $40.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work setting:

• Clinic
• Outpatient

People with a criminal record are encouraged to apply

Work Location: In person