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 Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode after normal business hours. Assesses and develops a plan of care in collaboration with the admitting, attending and consultant physicians, and other healthcare practitioners after normal business hours. The goal of the Case Manager is to effectively manage the patients during their hospitalization to assure the appropriate level of care is provided for the patient’s current severity of illness, utilizing the appropriate tests and diagnostics, in the appropriate facilities in order to provide the highest level of care, in the most efficient manner, while utilizing only the resources necessary for that episode of care after normal business hours. The Afterhours Case Manager is also responsible for developing a safe discharge plan and implementing the discharge plan for patients with the necessary resources to ensure that care is provided without interruption along the continuum of care, whether in a skilled nursing facility, assisted living facility, in the home setting, etc. after normal business hours. The Afterhours Case Manager will plan, coordinate, and collaborate with internal departments to ensure the patient is receiving the best coordination of care. The Afterhours Case Manager will document based on regulatory and contractual guidelines established by Federal, State, Local and Health plan guidelines, along with policies and procedures established by the Medical Management department. 

1. Perform clinical review upon admission and daily while patient is hospitalized
2. Assure appropriate level of inpatient care
3. Monitor inpatient stay to prevent delays in services and/or report aberrancy’s.
4. Identify and resolve barriers or potential barriers to safe transition and outpatient management.
5. Coordinate and assure all services for care transitions including transfer to lower levels of care, transfer to outpatient management, etc.
6. Educate members on post discharge instructions, outpatient physician follow-up, appropriate use of urgent care, and appropriate use of ER services.
7. Initiate and hand off case to Skilled Nursing Case Managers or Outpatient Management Programs (i.e. Vital Care, Hospice, etc) as appropriate.
8. Timely response to member needs – act in the moment.
9. Coordinate care for patients in the Emergency Room or Urgent Care to avoid an unnecessary acute inpatient admission.
10. Timely documentation based on regulatory and contractual guidelines established by Federal, State, Local and Health plan guidelines, along with policies and procedures established by the Medical Management department.
11. Creating and approving referrals for admissions and outpatient services based on Medical Management guidelines.
12. Creating letters for patients based on regulatory and contractual guidelines established by Federal, State, Local and Health plan guidelines, along with policies and procedures established by the Medical Management department.
13. Uses, protects, and discloses patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
14. Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality care and concern with each and every internal and external customer.
15. Seek assistance and escalate issues when needed from the Administrator on call, or Regional Medical Director on call for clinical oversight and decision making.
16. Participate in weekend rounds with Regional Medical Director and Hospitalists.

17. Perform other duties as assigned.

Required: Weekends required. 6-hour shifts on weeknights (5p-11p) or weekends for 12 hour shifts (8a-8p), including holidays (12 hour shifts).

*PER DIEM ROLE*