Cedars-Sinai Case Manager, LVN - Ambulatory Care Management in Beverly Hills, California
Summary of Essential Job Duties:
The care manager must have a demonstrated proficiency in the ambulatory care manager duties described below:
Care manager makes an outreach call within 24 hours of urgent referrals, 72 hours for routine referrals and initiates and or completes ACM assessment and care-plan.
Complete assessment for current/past medical conditions with dates of diagnosis, psychosocial issues, medications, ADL’s, pain assessment, assess for advance directive/POLST/DPOA, cultural/linguistic needs, mental status, depression screening, available benefits, member/caregiver goals, degree of involvement, and resources; barriers to treatment. Accurately document above assessment in CS-Link.
Consults with assigned Primary Care Physicians, as needed, to discuss status of new referrals and to discuss the status/treatment plan of patients enrolled in ACM.
Ensure managed care referrals are processed, per NCQA Guidelines, and appropriately documented in Access Express.
Process all appropriate services based upon covered benefits, health plan or Milliman Care Guidelines, or medical necessity:
Monitoring of continued appropriateness of the services rendered i.e. home health, DME, outpatient therapy.
Work collaboratively with social workers re: alternate housing or placement and notification of transfer SNF of ALF. Transitions of Care are accurately and consistently documented.
Transitions of Care Hand-Off, to assigned ISP CM, when ACM patients are admitted to CSMC.
Ambulatory case managers will contact the patients telephonically, within 48 hours, post-discharge.
Ambulatory Care Manager will meet patient, at physician appointments, as necessary, to build rapport with high risk individuals, or, when additional support is required.
Refer high risk patients to Supportive Care Services Program, and NP House Call Programs, as appropriate.
Coordinate referrals and secure appointment with various CSMNS Disease Management programs such as Anticoagulation Clinic, Asthma, Diabetes, Hepatitis C, Smoking Cessation, Cardiovascular Risk, as appropriate.
Graduation from an accredited school of nursing
Current California LVN licensure. BLS from American Heart Association required.
2-3 years of acute nursing experience; knowledge of medical/nursing standards of care; ability to effectively communicate and collaborate with physicians, patients/families, and ancillary staff to make sound, independent judgments and to act professionally under pressure; 1-2 years of previous experience in case management in the acute inpatient or outpatient settings; knowledge of HMO and Medicare rules in inpatient, home health and at the SNF settings. Bilingual (English/Spanish) highly preferred.
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.