Advanced Practice Registered Nurses / Physician Assistants
Job Specific Outcomes: * Identifies and evaluates members for enrollment into one of the Memorial Care Medical Foundation Case Management programs through physician referral, utilization data, inpatient referral, predictive modeling software, health plan referral, patient and family referral, and other sources as they occur. * Assesses, plans, implements, coordinates, monitors, and evaluates all options and services with the goal of optimizing and supporting the member’s health status and goals. * Integrates evidence-based clinical treatment guidelines, preventive guidelines, protocols, and other metrics in the development of Care Plans and Shared Action Plans. * Develops care plans and monitors outcomes of the plan that are adherent to regulatory requirements and are patient-centered, promoting efficiency and quality in the delivery of healthcare for the designated patient population. Modifies the care plan based on patient needs/stated goals and per department’s productivity standards and quality measures. * Works effectively with other members of the health care team and acts as liaison to optimize interventions. Coordinates services with appropriate physicians, facilities, contracted providers, and ancillary providers (disease management, behavioral health, social services and community resources) as indicated. * Is dedicated to the delivery of high-quality patient care and service, has a continuous learning approach to work, and finds opportunity in challenges and barriers. * Supports the organization’s goals and mission statement and in a professional manner. * Maintains comprehensive and confidential patient records in compliance with all HIPAA regulations. * Attends and participates in appropriate Patient Care Conferences, committees or related meetings, providing comprehensive and accurate case management reports and documents as required. * Maintains and complies with all MCMF policy and procedures. * Performs additional duties/tasks as assigned by the Supervisor and/or Manager.
Experience Required: * Work experience in Microsoft Word, Microsoft Excel and Microsoft Outlook. * Work experience applying evidence-based criteria (i.e.: MCG, lnterqual); Health plan medical policy / clinical coverage guidelines. * Clinical Nursing Experience in a hospital or like setting (2 years min)
Preferred: * Previous Case Management experience * Previous and or ability to learn use of electronic medical record, UM/CM platforms or electronic health record preferred. * Knowledge of CMS (Centers for Medicare and Medicaid Services) coverage policies required.
Education Required: * Current California Registered Nurse license (RN), Licensed Vocational Nurse (LVN) or MSW/LCSW * Associate's degree (AA) in nursing or equivalent from a two-year college or technical school.
Preferred: * Bachelor of Science in Nursing, Social Worker or equivalent. * CCM preferred.
MemorialCare Medical Group is a physician-based organization established to provide advanced comprehensive, effective and efficient health care. With over 30 locations from Long Beach to Dana Point, MemorialCare Medical Group includes more than 250 physicians in the areas of internal medicine, family medicine, pediatrics, geriatric medicine, cardiology, cardio thoracic surgery, gastroenterology, neurology, pulmonology, psychiatry, psychology, rheumatology, sleep medicine and therapeutic acupuncture. In addition to multiple locations throughout Orange County, MemorialCare Medical Group offers Urgent Care Centers that are open 365 days-a-year, Telephone Advice Nurses available 24 hours-a-day, 7 days-a-week; and lab and digital X-ray services available on-site at most locations.