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Outpatient Case Manager,

1 month ago

Covina, United States Regal Medical Group Full time
Job Description

Position Summary:

The Outpatient Case Manager-SNP will help to support the Case Management team in regards to handling the number of regulatory components that need to be completed to maintain regulatory compliance including health plans and CMS and NCQA standards.

Essential Duties and Responsibilities include the following:

  • Ability to manage assigned SNP Line of business and regulatory components that need to be completed in order to maintain regulatory compliance including health plans and CMS as well as NCQA standards.
  • Working knowledge of the SNP Model of Care and other CMS Health Plan regulations.
  • Responsible for reviewing available medical records available, review member case including claims, authorizations, review completed HRA on file received from the health plan , review all current care plans in place ,complete a telephonic assessment for a member and comprehensive 11 factor nation entry focusing on member care goal discussion , focusing on member identified priory goals.
  • Responsible for providing member educations, focusing on disease process of a member, with goal of member understanding of the diseases path.
  • Responsible for creation of member centric care plans for all noted conditions including a minimum of 30 individualized active care plans plus responsible for Interdisciplinary Care Team meeting and meeting minutes notation.
  • Assigned by manager as needed .
The pay range for this position at commencement of employment is expected to be between

RNs $45.00-50.00 per hour or LVNs$37.25 - $40.00 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 Requirements:
  • Valid LVN or RN active nursing license in CA
  • At least 2 years of acute or case management experience
  • At least 2 years of SNP experience
  • At least 2 years of managing a SNP line of business and thorough understanding of regulatory requirements and compliance and the SNP Model of Care