Outpatient Case Manager Lead - RN

Position Summary:

The Case Manager Outpatient RN Lead is responsible for the assessment, treatment, planning, intervention, monitoring, evaluation and documentation on identified RMG/LMG members. The Case Manager Outpatient RN Lead will educate and assist staff in developing a plan of care in collaboration with the Primary Care Physician, Specialists, and other health care practitioners. The Case Manager Outpatient RN Lead will assist the leadership with mentoring, training, and oversight of the performance of staff duties as requested. The Case Manager Outpatient RN Lead will assist with the triaging and assignment of new case management referrals. The goal of the Case Manager Outpatient RN Lead is to effectively manage patients on an outpatient basis to assure the appropriate level-of-care is provided, to prevent inpatient admissions, re-admissions, and to ensure that the patients' medical, environmental, and psychosocial needs are met over the continuum of care.

Essential Duties and Responsibilities include the following:

• Keeps patient/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.
• Assist with the training of new requirements from the health plans and HPN.
• Assist with chart auditing as necessary.
• Functions as liaison between administration, patients, physicians and other healthcare providers.
• Interacts professionally with patient/family/physicians and involves patient/family/physicians in formation of the plan of care.
• Communicates appropriately and clearly to management, co-workers, and physicians.
• Identifies and addresses psychosocial needs of the patients and family and facilitates consultations with Social Worker, as necessary.
• Receives and reviews physician's orders; documents completion. Follows, consults with other departments as appropriate to provide for an interdisciplinary approach to the patient's needs.
• Formulates an outcome-based plan or care, based on assessed patient needs, implements and evaluates plan as evidenced by documentation.
• Maintains quality as assigned by the Director.
• Documents patient assessment and reassessment, patient care plans, and other pertinent information completed in the patient's medical record in accordance with nursing standards and policies.
• Identifies community resources to address needs to cover through patient's benefit plans.
• Participates in the efficient, effective and responsible use of resources such as supplies and equipment.
• Responsible for the coordination and facilitation of patient and family conferences as determined by assessment of patient's needs.
• Responsible for the coordination of post-discharge clinic appointments, medication reconciliation, PCP and SPC visits.
• Identifies non-compliant members eligible for health plan disenrollment
• Responsible for identifying patients that are appropriate for hospice conversion or Palliative care.
• May also be responsible for co-management of discharged patients in the acute and skilled settings.
• Demonstrates the ability to formulate an appropriate outpatient care plan, based on a telephonic and in-person assessment of patients' needs and symptoms which addresses all key symptoms in order to effectively manage the patient on an outpatient basis.
• Provides oversight of staff duties as described in accordance with direction from department leadership.
• All other duties as directed by management.

The pay range for this position at commencement of employment is expected to be between $45 - $50 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.

Education and / or Experience:

• Graduate from an accredited Registered Nursing Program.
• Current CA RN license, current CPR certification.
• Minimum 6 months experience at Regal.
• 3 years acute care experience.
• 2-3 years of utilization or HMO experience preferred.
• Knowledge of computers, faxes, printers and all other office equipment.
• Typing 30 WPM with accuracy.
• Proficient in MS Office Programs (i.e., Word, Excel, Outlook, Access and PowerPoint).