Cedars-Sinai ISP Care Manager RN/LVN in Los Angeles, California
Are you ready to bring your expert clinical skills to a world-class facility recognized as one of the top ten in the United States? Do you have a passion for the highest quality and patient happiness? Then please respond to this dynamic opportunity available with one of the best places to work in Southern California! We would be happy to hear from you!
Our Case Managers conduct case management on patients in the inpatient, intensive outpatient, residential care and Skilled Nursing Facility settings. CSMNS has developed a case management program that is geared towards the management of patients while hospitalized and upon discharge from various care settings. Using the Case Management Society of America’s (CMSA) model, we describe our approach as “a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to ensure quality cost-effective outcomes.”
Summary of Essential Duties:
Handles outreach call within 24 hours of urgent referrals, 72 hours for routine referrals and initiates and or completes ACM assessment and care-plan, when needed.
Completes 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, when needed.
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, when needed.
Ensures managed care referrals are processed, per NCQA Guidelines, and appropriately documented in Tapestry. Monitors of continued appropriateness of the services rendered i.e. home health, DME, outpatient therapy.
Processes all appropriate services based upon covered benefits, health plan or Milliman Care Guidelines, or medical necessity
Collaborates with social workers re: alternate housing or placement and notification of transfer SNF of ALF, when needed.
Transitions of Care Hand-Off, to assigned ISP CM, when ACM patients are admitted to CSMC. Monitors the hospitalization of patients enrolled in ACM and maintain logs. Functions as the triage/resource to CSMNF Ambulatory Case Management operations, when needed.
Contacts the patients telephonically, within 48 hours, post-discharge. Meets patient, at physician appointments, as necessary, to build rapport with high risk individuals, or, when additional support is required, when needed.
Refers high risk patients to Supportive Care Services Program, and NP House Call Programs, as appropriate, when needed.
Coordinates and monitors referrals and secure appointment with various CSMNS Disease Management programs such as Anticoagulation Clinic, Asthma, Diabetes, Hepatitis C, Smoking Cessation, Cardiovascular Risk, as appropriate, when needed.
Manages staffing schedule, Assists with training new hires; oversees projects and initiatives as assigned, conducts documentation audits.
- Graduate of an accredited nursing program required
Current, unrestricted California RN or LVN license required
BLS from the American Heart Association or American Red Cross required
A minimum of 3 years of acute care nursing experience required
At least 1 years of Utilization Review, Case Management, Discharge Planning and HMO experience preferred
Certified Case manager (CCM) certification for RN’s
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.