RN Clinical Project Manager

The Clinical Project Manager is responsible is responsible for monitoring the care efficiency of the inpatient team through the movement of patients through the inpatient care experience. They are also responsible for knowing the contractual relationships and clinical capabilities of the inpatient facilities. Another responsibility is to monitor the transition process from community, institutional (skilled nursing, assisted living, congregate etc.) to and from acute (inpatient/long term care), including hospice. This position acts a liaison between the inpatient case manager, inpatient coordinator, BH, inpatient tertiary case management teams, patient advocacy, member services, finance/claims and other stakeholders involved in the inpatient care of our members.

The Clinical Project Manager’s overall responsibility is to constantly work in collaboration with other members of Medical Management Teams, for contributing to the clinical, quality, financial and patient satisfaction outcomes of Regal Medical Group.

Education and/or Experience:

1. Requires RN license, BSN preferred
2. Bilingual Armenian, preferred
3. 3+ years of Project Management Experience in Healthcare/Managed Care
4. Minimum 2 years of case management experience as a nurse preferred
5. High level knowledge of Concurrent Review/Case Management processes and principles
6. Prior experience in MSO environment preferred.
7. Ability to work with all levels of management.
8. Must have excellent communications skills both verbally and written.
9. Must have excellent organizational skills.
10. Prior experience with project development and implementation preferred.
11. Required to travel for new client implementation.
12. Requires current CA driver’s license and car insurance

Essential Duties and Responsibilities include the following:

1. Coordinates a team of employed and contracted health care professionals (physicians, nurses, social workers, pharmacists, and other allied health professionals to optimize the patient transition experience form inpatient to community setting by managing home health visits as an instrument to improve patient safety and quality outcomes.
2. Coordinates activities from the various stakeholders (the patient, family members and friends, hospitalists, inpatient case management, PCP, visiting physicians and nurses and others) to create a seamless patient experience of transition of care.
3. Develops, monitors, and analyzes reports and identifies trends to develop programs and processes that improve program outcomes.
4. Identifies and assists in the development of Concurrent Review policies and procedures and assists the Medical Director to oversee compliance and consistency of the program that meets RMG and regulatory standards.
5. Assists with the development and implement of training plans for new and existing staff.
6. Acts as a resource for clinical staff for case review and discharge planning.
7. Develops and coordinates strategies across the continuum of care for ensuring the delivery of care in the most cost effective setting.
8. Works with management on a daily basis to review all clinical programs hospitalizations with both home visit staff as well as concurrent review staff for level of care and discharge planning, including review of face sheets and assuming a nurse leadership role with home visit review rounds. Will assist with cases in need of complex case management.
9. Collaborates with management to analyze data and implement programs that will improve patient outcomes.
10. Develops annual department goals and objectives focused on improving patient outcomes and department efficiency.
11. Acts as a role model for staff appropriate case manager and customer service behaviors.
12. Works collaboratively with the entire Medical Management team to ensure compliance with regulatory and health plan requirements.
13. Participates in “on call” process as needed for training and monitoring of home review staff.
14. Develop working relationships with hospital case management departments to facilitate timely reviews.
15. Oversees “triage” of patients to the appropriate level of care for the members of the home health team, and acts as a resource to other concurrent review nurses in the transfer process.
16. Works closely with other departments (claims, finance, high risk, CM, TOC) as needed.
17. Assumes other responsibilities as assigned.
18. Anticipate our customer needs: Understand the wants and needs of customers, listen for cues and identify how to respond and what level of intervention they need.
19. Survey the customer’s environment and take appropriate action.
20. Refrains from discussing personal business in front of the customer or speak a foreign language different from the customer’s language.
21. Greets patients, family members, and visitors, physicians in a positive manner by introducing self, speaking clearly and with confidence.
22. Returns phone calls to customers and follows up with requests.
23. Keeps patient/family member or other customer informed and requests if further assistance is needed.
24. Assists others and supports the team.
25. Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
26. Demonstrates honesty and integrity in everyday activities.
27. Protects privacy for both patients and employees; ensures information sensitive papers, charts, and reports are not in view of the public.
28. Recognizes when an error has been made and immediately reports to appropriate manager.
29. Participates in “service recovery” through follow-up with an upset customer, gathering information, and demonstrates empathy.
30. Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families. Functions as liaison between administration, patients, physicians, and other healthcare providers.
31. Interacts professionally with patient/family/providers and involve patient/family/providers as appropriate.
32. Communicates appropriately and clearly to management, co-workers, and physicians.All other duties as directed by management.
33. Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.
34. Documents appropriately pertinent information completely, in the in the authorization system according to nursing standards and policies.
35. Pursues additional education (in-services, seminars, self-study, and formal education programs) to advance nursing skills and knowledge.
36. Responsible for orientation, instruction/training of new personnel.
37. Maintains quality monitors as determined by the Utilization Management and Quality Management Committees and RMG Management.
38. Consults other departments as appropriate to provide for an interdisciplinary approach to the patient’s needs.
39. Understands and applies principles of adult learning methods as they relate to health care educational needs.
40. Communicates using age appropriate language.

Organizational Responsibilities :

1. Proactively support and practice company mission, vision and values.
2. Follow Employee Handbook guidelines and company policies and procedures.
3. Follow established departmental dress code.
4. Appropriately and accurately maintain time keeping records.
5. Adhere to attendance policy and time off requests.
6. Follow safety policies and procedures.
7. Be flexible and adaptable and courteous and promote professionalism.
8. Communicate verbally and in writing through appropriate channels.
9. Maintain confidentiality at all times in compliance with company policy and HIPAA requirements.

The pay range for this position at commencement of employment is expected to be between $104k year; 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.

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.

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.