Inpatient Case Manager After Hours
3 months ago
Position Summary:
The After Hours Nurse Case Manager performs triage functions by providing support and guidance, linking members and their families to healthcare services that meet their needs and serving as a communication bridge amongst and between members, families and the care team. Coordinates resources into a seamless model of access, care and support. Responds to and coordinate service request for transfers, request for admissions, ancillary service request, and facilitate discharges to lower levels of care. Demonstrates self-direction in establishing priorities and working with little supervision. Maintains high level of precision in judgment, accuracy of assessment, and skill in problem solving under stress. Relates and communicates well over the telephone to all callers.
Essential Duties and Responsibilities include the following:
- Receives, triages, and responds to telephone calls from members requiring medical and nursing advice
- Performs comprehensive telephonic patient assessment, evaluation and advice while meeting production standards.
- Assesses patient problems utilizing approved guidelines, directing access to care to include emergent care, urgent care, routine and same day appointments, follow-up and self-home care based on outcomes of nursing assessment
- Follows established clinical protocols/guidelines and provides appropriate patient instructions.
- Directs patient to appropriate levels of care based on assessment within the established guidelines.
- Communicates to On-Call physician member calls requiring physician involvement, intervention, or follow-up
- Facilitates authorizations for vendors and/or outside services as appropriate.
- Provides health education and instructions to patients and their families on health maintenance and disease prevention utilizing appropriate guidelines
- Receives, triages, and responds to telephone calls from hospitals, vendors and physicians requesting facilitation of requested services
- Documents all calls according to established standards
- Completes medical documentation of telephonic assessment and disposition in the medical record.
- Participates in quality monitoring process.
- Translates oral information into concise and accurate written documentation using standard medical guidelines and abbreviations.
- Recognizes financial, medical and legal risks based on data collected during customer interactions and follows appropriate procedures.
- Demonstrates customer service-oriented behavior at all times.
- Acts as a mentor as requested by supervisor.
- Expedites emergency calls as needed.
- Accesses Language Line for non-English speaking patients as needed.
- Participates in regular staff meetings as scheduled.
- Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
- Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
- Performs additional duties as assigned.
The pay range for this position at commencement of employment is expected to be between for LVN's $37.50 - $40 per hour or for RN's $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.
Requirements
Education and/or Experience:
- Graduate of an accredited nursing program
- Registered Nurse or Licensed Vocational Nurse licensed in California
- Current basic life support (BLS) certification
Experience
- Minimum 3 years of clinical experience in a medical-surgical or other specialty
- 1 - 2 years Case Management experience. Managed care experience preferred
- Emergency department triage experience preferred (walk-in or telephone)
- High levels of experience or expertise in:
- Crisis intervention
- Teaching/coaching
- Disease management
Skills
- Good judgment and critical-thinking skill
- Compassionate and caring manner with patients
- Telephone "charisma"
- Forms instant rapport
- Customer service-oriented
- Helpful, warm, open, and inviting
- Excellent communication skills (written, verbal, and technical)
- Articulate
- Able to communicate well at fifth- to eighth-grade level
- Bilingual language skills a plus
- Concise, clear documentation skills
- Excellent listening skills
- Excellent negotiation skills
- Proven typing skills at 30 words per minute with accuracy
- Knowledge of computers, faxes, printers and all other equipment
- Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)
Attributes
- Functions well in a high-stress environment and under time pressure
- Tolerates ambiguity well
- Works well independently
- Works effectively with:
- Culturally diverse populations
- Educationally diverse and illiterate populations
- Non-English-speaking populations
- High-risk populations
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