Full time

Care Navigators On Demand; Newhall (IA); In loco; USD 90.000 - 120.000; Tempo pieno

Descrizione del lavoro

Care Navigators On Demand in Newhall, CA, seeks an experienced Nurse Case Manager to lead clinical care coordination, utilization management, discharge planning, and outcomes management within an acute care setting.

You will oversee MediCal TAR processes, ensure regulatory compliance, develop workflows, and mentor care teams while working with patients, families, clinicians, and health plans.

Competenze

• Knowledge of the theory, principles, and practices of case management and social services.
• Knowledge of patient rights.
• Knowledge of management and supervision including planning, organizing, directing, motivating, controlling and decision making.
• Ability to communicate effectively with individuals at all levels and from all backgrounds both orally and written.
• Ability to set priorities appropriately and handle multiple issues concurrently.
• Ability to establish and monitor departmental and corporate goals.
• Ability to motivate subordinates to work effectively and efficiently.
• Strong critical thinking skills with the ability to work independently as well as in teams.

Mansioni

• Provides leadership and management of clinical carecoordination, utilization management, discharge planning, and outcomesmanagement.
• Oversees the MediCal TAR process...
• Manages the systems, processes, and outcomes ofclinical care teams and programs designed to address clinical andfinancial needs of patients and families.
• Responsible for goal setting, program planning, workflow processes, regulatory compliance, staff productivity, facilitation ofwork teams, quality of work, outcome evaluation and continuous qualityimprovement.
• Represents the hospital to internal and externalcustomers, including patients and families, physicians, service lineleadership, administration, and health plans.
• Maintains professional and collaborative relationshipswith the hospital administration, staff, physicians, service lineadministration, other internal and external customers, including healthplans, medical groups, patients and families.
• Develops and maintains a positive working relationshipwith the Physician Advisor of the facility to ensure correct patientclassifications, timely denials management, and development ofcollaboration with physician members and other departmental leaders withinthe hospital.
• Participates in Utilization Review Committee functions.
• Knowledge of State and Federal Regulations includingbut not limited to EMTALA, MediCal, Medicare, and HMO’s.
• Contributes toward effective, positive workingrelationships with internal and external colleagues.
• Demonstrates cooperation, flexibility, reliability anddependability in all daily work activities.
• Demonstrates a willingness to collaborate with othersfor the good of the customer and the organization.

Conoscenze

Leadership

Communication

Prioritization

Critical thinking

Collaboration

Formazione

Baccalaureate in Nursing

Master’s degree preferred

Strumenti

McKesson InterQual

Descrizione del lavoro

Newhall, United States | Posted on 08/21/2019

• Provides leadership and management of clinical carecoordination, utilization management, discharge planning, and outcomesmanagement.
  
• Oversees the MediCal TAR process...
  
• Manages the systems, processes, and outcomes ofclinical care teams and programs designed to address clinical andfinancial needs of patients and families.
  
• Responsible for goal setting, program planning, workflow processes, regulatory compliance, staff productivity, facilitation ofwork teams, quality of work, outcome evaluation and continuous qualityimprovement.
  
• Represents the hospital to internal and externalcustomers, including patients and families, physicians, service lineleadership, administration, and health plans.
  
• Maintains professional and collaborative relationshipswith the hospital administration, staff, physicians, service lineadministration, other internal and external customers, including healthplans, medical groups, patients and families.
  
• Develops and maintains a positive working relationshipwith the Physician Advisor of the facility to ensure correct patientclassifications, timely denials management, and development ofcollaboration with physician members and other departmental leaders withinthe hospital.
  
• Participates in Utilization Review Committee functions.
  
• Knowledge of State and Federal Regulations includingbut not limited to EMTALA, MediCal, Medicare, and HMO’s.
  
• Contributes toward effective, positive workingrelationships with internal and external colleagues.
  
• Demonstrates cooperation, flexibility, reliability anddependability in all daily work activities.
  
• Demonstrates a willingness to collaborate with othersfor the good of the customer and the organization.
  

Job Requirements

Knowledge, Skills, Abilities

• Knowledge of the theory, principles, and practices ofcase management and social services.
  
• Knowledge of patient rights.
  
• Knowledge of principles and practices of management andsupervision including planning, organizing, directing, motivating,controlling and decision making.
  
• Ability to communicate effectively with individuals atall levels and from all backgrounds both orally and written.
  
• Ability to set priorities appropriately and handlemultiple issues concurrently.
  
• Ability to establish and monitor departmental andcorporate goals.
  
• Ability to motivate subordinates to work effectivelyand efficiently.
  
• Possess strong critical thinking skills with theability to work independently as well as in teams.
  

Education/Experience

• Baccalaureate in Nursing strongly preferred. Master’sdegree a strong plus.
  
• Minimum of three years in acute care Case Managementpreferably in a leadership role.
  
• Valid RN License in the State of California.
  
• Current BLS Card issued by the American HeartAssociation.
  
• ACM preferred.
  
• McKesson InterQual experience preferred.
  

ADA/Physical Demands

• To perform this job successfully, and individual mustbe able to perform each essential job duty satisfactorily. Therequirements listed are representative of the knowledge, skill and abilityrequired. Reasonable accommodation may be made to enable individuals withdisabilities to perform the essential functions. Such accommodations mustbe requested by the employee/applicant in order to be considered.
  
• Required to stand; walk; sit; use hands to fingers,handle, or feel; reach with hands and arms; stoop, kneel, crouch or crawl;talk and hear; and may taste and smell. The employee is regularly requiredto lift, push and or pull weights in excess of 10 pounds with assistance.Visual abilities, auditory abilities must be intact to perform duties.
  

Requirements

Education/Experience

• Baccalaureate in Nursing strongly preferred. Master’sdegree a strong plus.
  
• Minimum of three years in acute care Case Managementpreferably in a leadership role.
  
• Valid RN License in the State of California.
  
• Current BLS Card issued by the American HeartAssociation.
  
• ACM preferred.
  
• McKesson InterQual experience preferred.
  

Care Navigators On Demand is an Equal Opportunity Employer and does not discriminate on the basis of race or ethnicity, religion, sex, national origin, age, veteran disability or genetic information or any other reason prohibited by law in employment.