RN Case Manager - Full Time, Days (Culver City)

Position Summary

The CRC Chronic Care Manager for Population Health and Value Based Care will facilitate coordination, communication, and collaboration with patients/members, providers, ancillary services, and leadership to achieve goals and maximize patient/member outcomes through an innovative whole person chronic care strategy by working with CRC, Hospitals, MSOs and IPAs. Best practice focus will be placed on the provision of care in the ambulatory care settings, efficient patient/member management through chronic care management and leadership escalation to ensure appropriate use, level of care and timeliness of services. The Chronic Care Manager for Population Health and Value Based Care will promote the vision and be responsible for the implementation of these strategic objectives.

Essential Job Functions / Major Areas Of Responsibility

In partnership with the Director, the Chronic Care Manager for Population Health and Value Based Care ensures the aforementioned programs are a collaborative process of identification, assessment, planning, intervention, coordination and evaluations and as appropriate: integrates the participation of all those involved in the care of the member, including the primary care physician, medical and surgical specialists, nurses, behavioral and mental health specialists, physical, occupational, and speech therapists, social workers, allied health professionals, and community-based providers. On an ongoing basis, the Chronic Care Manager for Population Health and Value Based Care assures the following goals are achieved, including, but not limited to:

• Proactively identifying members with serious and complex conditions
• Screening and identifying appropriate patients for the CCSPIP
• Maximizing members optimal functioning, management of their chronic conditions, and working to enhance the member's independent living capabilities in concert with the Medical Director, Director of Population Health and Care Management, Social Worker(s) and CTC/CHW
• Facilitating the continuity and coordination between providers, facilities, community resources and the health plan
• Facilitating interdisciplinary communication, care planning, and member compliance with the physician's treatment regimen
• Enhancing member satisfaction with Prospect's health care delivery system
• Coordinating member's eligible benefit coverage to best serve their medical conditions and social needs
• Utilizing creative solutions to assist in-patient care managers with complex vulnerable and underserved patients who are difficult to place upon discharge; through the coordination of cost-effective alternatives, especially as they relate to CalAIM
• Developing an individualized, comprehensive, multidisciplinary care plan that best meets the member's medical and psychosocial needs and
• Providing consistently positive, constructive interface with internal departments and physicians as needed
  
  

Required Qualifications

• Current Licensure as a CA Registered Nurse required. Board Certified Nurse Practitioner (NP-BC) preferred.
• AHA Basic Life Support.
• AHA Advanced Cardiac Life Support
• Seven (7) years of experience in an acute care role, with at least three (3) years in a care management level role required.
• Must have care management leadership and medical group/MSO care management experience
• Must have excellent verbal and written communication skills with fast paced problem-solving skills and the confidence to quickly implement resolutions.
• Skills to independently utilize software such as Outlook, Word, Visio, Power Point, and Excel, as well as electronic health record documentation (i.e. Allscripts) and research expertise.
• Fluency of standard care management and utilization screening tools such as MCG and InterQual. InterQual.
• Hold a keen understanding of Daily Discharge Multi-Disciplinary Meetings, advanced experience with Allscripts Care Management tools, or other like management tools.
• Must hold experience with Care and Population Management & EMR Systems; such as, EPIC, Meditech, Cerner, Allscripts Care Management, knowledge of DRG, value based, risk based (capitation) and per diem payment methodologies.
• Must hold knowledge of all Federal, State and Local regulatory standards, have an advanced level knowledge of healthcare systems and applications to be able to successfully plan and coordinate activities and serve as a key resource to staff and others across the organization.
• Previous experience across multiple healthcare settings (in-patient acute care, ambulatory.
  
  

Preferred Qualifications

• MCG Certified Instructor
• Previous experience in long-term care.
  
  

The Chronic Care Manager for Population Health and Value Based Care will have responsibility for these complex care management functions:

• Ambulatory Case Management – Complex and High Intensity
• Disease Management Programs
• Complex Care Services Performance Improvement Program (CCSPIP)
• Initial and On-Going Chronic Care Planning
• Subject Matter Expert (SME) for CalAIM initiatives
• Content development, professional expertise and/or care provision for Medicaid and Medicare members
  
  

Pay Rate: Min - $58.32 | Max - $82.48

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