CareManager, RN Outpatient Clinic
Shriners Hospitals for Children - Los Angeles, CA
Shriners Hospitals for Children Los Angeles is currently seekingto hire a Care Manager, RN for our Outpatient Clinic.
The Care Manager, RN is an integral member of the AmbulatoryServices team in our Outpatient Clinic. The person in this position will need to have a thorough understanding of clinical, financial, administrative, and psychosocial components of care management. The Care Manager, RN is responsible for providing assessments, planning, interventions and follow-up for patientsand family members at ShrinersHospitals for Children(SHC) across the continuumof care. These services are provided face to face or telephonically; to facilitate the creationand adherence to a treatment plan and optimize patient health. In conjunction with the interdisciplinary team; this position proactively addresses potential or actual needs identified through screening to ensuredevelopmental, level of care and healthstatus transitions are safe, seamless, and coordinated.
Advocates for the patientand his/her family while adheringto the overall treatmentplan; UR/UM guidelines; policies and procedures of SHC; state, regulatory requirements and nursingand case management standardsof practice.
Work collaborativelywithinterdisciplinary teamconsisting of Social Worker,Resource Navigator, Patient Access,HIM, CDI/UM Specialist, URSpecialist, Corporate staff and others;to meet the overall goals of theorganization and metricsspecific to the assigned facility.
PerformIntake assessments of new patients at initial visit or by phoneprior to first appointment, basedon stratification criteria.
Works to ensurepatient s coordinated care by collaborating and communicating with patient s MedicalHome and/or other health care providers
Provides discharge/transitionassessments, identifying barriers that affect length of stay, identifying barriersto successful clinical outcomes, developing plan of care, facilitates interventions and evaluatesadherence to treatment plan through proactive patient engagementfor care transitions acrossthe care continuum.
Obtains authorizations for post SHCcare and services as requiredby patient s benefits, entitlement programs,or charitable resource.
Discuss gaps in adherence with clinical team, and facilitate interventions.
Facilitates co-management withthe medicalhome for episodes of care.
Ensureshand off communication withnext level of care, postdischarge and after exit fromsystem.
Works with providers, patient/family to facilitate medication management/adherence through proactive follow-up.
Assessment for financial barriersto adherence and discussespatient/family financialobligations for post SHCcare and services.
Reviews authorizationfor services, orders anddocumentation to support medicalnecessity and level of care, prior to and duringencounters, in conjunction with CDI/UM specialists andpatient access.
Makesdaily contact with inpatients and clinicalcare team to ensure timely care and services, identify needs anddevelop action plans.
Provides anticipatory guidanceabout health care benefitsto minimize over/under utilization and decrease fragmentation of care.
Address gaps in carewith external case management or primary care, andmakes referrals as needed.
Performs developmental touchpoint assessments for patientswith children with medicalcomplexity, basedon stratification criteria.
Discusses anddocuments agency and facility choices for post SHC services.
Assures patients/family haveknowledge to manage care, manage health,prevent secondary disabilities and are empowered to beresponsible for participating in planof care.
Documents assessments, interventions, plans, and educationin the patient s electronic medical record.
Obtains/evaluates/synthesizesnew knowledge that is applicable to practiceand leads others in applying it.
Increases knowledge through participationin professionalassociations, presentations, publications, literature review andeducational opportunities and shares information freelywith others.
Participates insystem wide development of clinical best practice pathways,patient education materials, ordersets and implements successfully.
ASN Degree required.
BSN Degree strongly preferred or 15+ years ofclinical experience preferred if candidate does not possess the BSN.
3-5 years of clinical experience in one or moreof the hospital s servicelines (SCI, Pediatric orthopedics, Burn care, Cleft lip and palate) preferred.
3-5 years Care Coordination/CaseManagement experience is preferred
Current California Registered Nursing License. In good standingrequired.
Current CaseManagement Certification is preferred.If candidate is not currently certifiedincase management, certification by CCM or ACM willbe required within 6 monthsof hire or upon eligibility.
CurrentBLS certification required.
CurrentPALS certification required.
Current LACounty Fire Card required.
Pediatric, orthopedic, burn, or rehabilitation environment experiencepreferred.
Bi-lingual English/Spanish strongly preferred.
Associated topics: ambulatory, asn, cardiothoracic, care, hospice, intensive care, mhb, nurse clinical, surgery, transitional
• Post ID: 145370127 losangeles