Providence Health & Services Complex Care Case Manager RN in Los Angeles, California
Providence is calling a Complex Care Case Manager Registered Nurse (Full Time/Day Shift) to our Providence Medical Institute Axminster Managed Care locations with one position open in Ladera Heights, CA and one position open in Hawthorne, CA.
The Complex Care Management (CCM) Program, managed by telephonic nurse care managers, offers intensive case management for those who suffer from multiple chronic conditions and catastrophic illnesses. CCM manages the high risk, Special Needs Program (SNP) and Cal Medi-connect (CMC) populations.
These individuals can face a variety of complications and are in need of assistance in coordinating multiple services, such as pain and symptom management, home health, provider home visits, home based palliative or terminal care needs, assistance with daily living, or a range of other types of support.
The ultimate goal is to identify our high risk patients and to dedicate the needed resources to facilitate their care, improve their health and prevent avoidable hospitalizations.
In this position you will be responsible for:
Utilization review and discharge planning for capitated patients who are hospitalized.
The review includes coordination of services for medical necessity, cost effectiveness, timelines of service and ensuring that quality standards are met.
Performs coordination of services for patients whose health plan has an at-risk agreement to ensure that services are medically necessary, cost effective, provided in a timely manner and meet local standards or care.
Required qualifications for this position include:
RN graduate of an accredited school of nursing required.
Current California RN license and American Heart Association BLS for Health Care Providers required.
Must possess excellent customer service and communication skills.
Must be organized and a self‑starter, be able to utilize multiple resources to determine health plan requirements and benefits as applied to the utilization and case management process and clinical decision making.
Must have working understanding of MS Outlook, Word and Excel and be capable of being trained in referral processing software.
Preferred qualifications for this position include:
Bachelor’s degree preferred.
Strong clinical background preferably in acute care.
Three to five years experience in a managed care setting/utilization review/discharge planning/case management/ patient education.
About the Providence Medical Institute you will serve:
Providence Health & Services Southern California is further developing its physician integration strategy. Historically, the largest asset has been Providence Medical Institute, a medical foundation that provides administrative and other support services to affiliated medical groups. Providence Medical Institute is expected to grow significantly in the next several years, bringing with it facilities, staff and physician growth to support that objective.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Case Management
Location: California-Los Angeles
Req ID: 154483