Aco Case Manager, Rn/Lvn

As one of the fastest growing Independent PhysicianAssociations in Southern California, our medical group offers a fast-paced,exciting, welcoming and supportive work environment. Opportunities abound, andenterprising, capable, focused people prosper with us. We promote teamwork,nurture learning, and encourage advancement for all of our employees. We wantto see you excel, because we believe that your success is our success.

We currently have an opening for an ACO Case Manager
Our ACO Case Managers will strategically manage services for specified patientpopulations. They will provide a focus on wellness, prevention, and efficientcare through the coordination with their patients, their patient's families andtheir physicians. The education of the patient and his/her family will beincorporated into the care plan after careful assessment of the patient'sknowledge base, home life, and post-acute resources. 
ACO Case Managers will play a vital role in the clinical, financial andeducation of patients and will ensure these aspects are all consideredsimultaneously throughout the continuum of care. ACO Case managers will ensurethe patient receives the right services at the right level of care and willassist the patient in navigating their own care at an optimum level. 

1. Keeps Beneficiary/family of beneficiaries or other customers informed andrequests if necessary, further assistance when needed.
2. Communicates the ACO Care Coordination process to Beneficiary/family/physiciansand other Care Coordination team members explaining beneficiary's right torefuse care coordination (opt-out) and accept (opt-in) as desired and thebenefits of the program to the Beneficiary/family/physicians at no cost to theBeneficiary.
3. Demonstrates the ability to follow through with requests, sharing ofcritical information, and getting back to individuals in a timely manner.
4. Functions as liaison between administration, Beneficiaries, physicians andother healthcare providers.
5. Interacts professionally with Beneficiary/family/physicians and involvesBeneficiary/family/physicians in formation of the plan of care.
6. Develops an outcome-based plan of care, based on the Beneficiary's input andassessed Beneficiary needs. Implements and evaluates the plan of care as oftenas needed as evidenced by documentation in the Beneficiary's case file withclear and concise Beneficiary focused goals and outcomes.
7. Documents Beneficiary assessment and reassessment, Beneficiary care plans,and other pertinent information completed in the Beneficiary's medical recordutilizing critical thinking skills and in accordance with the FOCUS Chartingmethodology, nursing standards, and company policies and procedures. 
8. Educates the Beneficiary/caregiver on the transition process and how toreduce unplanned transitions of care.
9. Communicates appropriately and clearly with physicians and Beneficiary CareManagers.
10. Identifies and addresses psychosocial needs of the beneficiary's, familyand facilitates consultations with Social Worker, as necessary.
11. Identifies community resources to address needs not covered by theBeneficiary's benefits, and coordinates Beneficiary benefits as needed, withthe community resources where available.
12. Responsible for the coordination and facilitation of Beneficiary and familyconferences as determined by assessment of Beneficiary's needs telephonically.
13. Responsible for the coordination of post-discharge clinic appointments,medication reconciliation, PCP and SPC visits.
14. Ability to collaborate and communicate with all members of the healthcareteam (concurrent review, PCP/SPC, Social Services) to coordinate the continuumof care of developing plans for management of each case, and participation inthe interdisciplinary team.
15. Responsible for the identifying beneficiaries that are appropriate forhospice conversion or Palliative care, and assist the beneficiaries and/ortheir families in accomplishing this process if requested.
16. Distribution of work: Daily production will vary from day to day. Allassigned work must be completed by the end of business day in order to maintaincustomer service to High Risk patients.
17. Protects privacy for both beneficiaries and employees; ensuring allpersonal health information is kept confidential-complies with HIPPAregulations.
18. Other duties as assigned.

Qualifications

1. Graduate from an accredited Registered Nursing Program orLicensed Vocational Nursing Program.
2. Current CA RN, or LVN license, valid CA Driver's license.
3. 3 years acute care or care management experience.
4. Typing 40 words per minutes with accuracy.
5. Knowledge of computers, faxes, printers and all other office equipment.
6. Knowledgeable in MS Office Programs (i.e., Word, Excel, Outlook, Access andPowerPoint)
7. Possible on call duties as assigned.
We offer a full benefits package which includes employer paid medical, pharmacyand dental benefits. We offer a generous PTO package, 401k Retirement Savings,Life Insurance, Flexible Spending Account (FSA), Tuition Reimbursement &Licensed Renewal Fees for our clinical staff.
Employer will consider for employment qualified applicants with criminalhistories in a manner consistent with the requirements of the LA City FairChance Initiative for Hiring Ordinance.

City: Granada Hills

Exempt: No