Job Posting: The Ambulatory Care Manager's primary responsibility is to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. In collaboration with the CSMG, CSHA, CI Primary Care Physicians and specialists, the program is designed to assist patients at the time they are identified as a candidate for ACM in assessing patient's needs, coordinating care, communicating with health plans to determine benefits and referring to ancillary programs i.e., Disease Management, Nurse Practitioner House Call Program, Palliative Care. All above actions are aimed at decreasing unnecessary emergency room visits, hospital admissions, as well as, reduce 30-Day readmission rate. The care manager will reinforce the foundations of ACM: increasing quality of patient access and care, while reducing the total cost of care. This includes managing transitions of care for all CSMNF patients. The Ambulatory Care Manager must have extensive background of the care management operations. The essential job duties detailed below. Essential Job Duties: The care manager must have a demonstrated proficiency in the ambulatory care manager duties described below: a) Care manager makes an outreach call within 24 hours of urgent referrals, 72 hours for routine referrals and initiates and or completes ACM assessment and care-plan. b) Complete assessment for current/past medical conditions with dates of diagnosis, psychosocial issues, medications, ADL's, pain assessment, assess for advance directive/POLST/DPOA, cultural/linguistic needs, mental status, depression screening, available benefits, member/caregiver goals, degree of involvement, and resources; barriers to treatment. Accurately document above assessment in CS-Link. c) Consults with assigned Primary Care Physicians, as needed, to discuss status of new referrals and to discuss the status/treatment plan of patients enrolled in ACM. d) Ensure managed care referrals are processed, per NCQA Guidelines, and appropriately documented in Access Express. e) Process all appropriate services based upon covered benefits, health plan or Milliman Care Guidelines, or medical necessity: f) Monitoring of continued appropriateness of the services rendered i.e. home health, DME, outpatient therapy. g) Work collaboratively with social workers re: alternate housing or placement and notification of transfer SNF of ALF. Transitions of Care are accurately and consistently documented. h) Transitions of Care Hand-Off, to assigned ISP CM, when ACM patients are admitted to CSMC. Ambulatory case managers will contact the patients telephonically, within 48 hours, post-discharge. i) Ambulatory Care Manager will meet patient, at physician appointments, as necessary, to build rapport with high risk individuals, or, when additional support is required. j) Refer high risk patients to Supportive Care Services Program, and NP House Call Programs, as appropriate. k) Coordinate referrals and secure appointment with various CSMNS Disease Management programs such as Anticoagulation Clinic, Asthma, Diabetes, Hepatitis C, Smoking Cessation, Cardiovascular Risk, as appropriate. In addition, the care manager is expected to be able to: 1) Pass documentation audits 2) Monitor new patient referrals 3) Monitor the hospitalizations of the patients enrolled into ACM and maintain logs #LI-SR1 GD-MDN
Qualification Requirements/Preferences: Education Certifications/Licensure Experience Physical Abilities Graduation from an accredited school of nursing; current California RN or LVN licensure; 3-5 years of acute nursing experience; knowledge of medical/nursing standards of care; ability to effectively communicate and collaborate with physicians, patients/families, and ancillary staff to make sound, independent judgments and to act professionally under pressure; 1-2 years of previous experience in case management in the acute inpatient or outpatient settings; knowledge of HMO and Medicare rules in inpatient, home health and at the SNF settings. Preferred candidates are Certified Case manager (CCM) certification for RN's, utilization review (UR) experience, and minimum of BSN (Bachelor of Science degree in Nursing). PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand and talk or hear. The employee frequently is required to walk; sit; and use hands to finger, handle, or feel. The employee is occasionally required to reach with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, color vision, depth perception, and ability to adjust focus.
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scien...tists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major teaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.