RN Chronic Care Manager, Population Health/Value Based Care - Full Time, Days (Hybrid LA County)

• The Chronic Care Nurse Care Manager implements programs within assigned areas. Position requirements includes a thorough knowledge of the organization's policies, procedures, workflow, monitoring and oversight tools, employee relations, company goals and vision. Chronic Care Nurse Care Manager must have strong leadership skills with the ability to influence and motivate interdisciplinary team members. Successful Chronic Care Nurse Care Manager will have persistence to challenge and move patients through the continuum without losing focus of the quality and cost of care
• The Chronic Care Nurse Care Manager sees patient and system challenges and obstacles as opportunities for innovation and success. This person possesses the ability to work independently, remotely and has a passion to create a lasting impact on patient's lives and health.
• Chronic Care Nurse Care Manager must have the ability to prioritize competing demands and promote a multidisciplinary team approach with strong problem-solving skills and attention to detail. Is responsible for consistent operational compliance and reporting to satisfy and exceed state, federal and accrediting agency standards.
• Must have experience implementing new programs, which includes but is not limited to those which support the management of patients with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admission. The Chronic Care Nurse Care Manager ensures that Members' medical, environmental, and psychosocial needs are optimized through the continuum of care.
• Chronic Care Nurse Care Manager participates as needed in physician/hospitalist, daily and weekly operational, department meetings, JOCs and MSO daily rounds meetings as delegated by the Medical Director or Population Health and Care Management Director. Chronic Care Nurse Care Manager assists Medical Director and Population Health and Care Management Director with the daily clinical operations, compliance, and oversight of programs. Participates as the liaison and contact for operational teams members and is responsible for communication, coordination and monitoring of organization-wide chronic care initiatives and operations related to in/outpatient case management programs.
• Plans, develops, implements, evaluates, refines care management/social work intervention, and provide coaching and guidance to the Clinical Management staff for effective and efficient operation of social services, community care and other chronic care management programs.
• Participates in the daily management of care and disease management functions, daily in-patient rounds, MSO in/out-patient high intensity rounds, home visits, social workers, palliative, hospice and home medication therapy management programs. Interfaces with CRC and MSO Medical Directors and attends / participates in Interdisciplinary Rounds.
• Works collaboratively with Medical Director and Population Health and Care Management Director to ensure compliance is maintained, identifies specialist issues, reviews re-admissions and avoidable admissions.
• Coordinates provisions for complex ambulatory care (disease management, social services, behavioral health, palliative/hospice, health education, community resources, etc.)
• Demonstrates consideration for the needs, clinical and financial, of the patients, payers, CRC clinical and partner MSO | IPA team members. Implement and support a culture of continuous quality improvement, regulatory and accreditation code of professional conduct, and the federal and state regulations on confidentiality, as well as all policies and procedures Prospect Medical Holdings Hospitals.
• Coordinates the collaboration with patient's family and physicians for seamless coordination of care and services. Monitors and evaluates effectiveness of the chronic and end of life care management plan(s) and modifies as necessary to meet health plans and national standards (i.e., NCQA and DMHC requirements) for turn-around-time for assessments, care plans and IDTs.
• Identifies and implements Initial Care Plan (ICP) by conditions identified in CCSPIP, patient assessment, medical records, authorizations/referrals, primary care physician, hospitalist, member and interdisciplinary team. Works to develop patient prioritized self-management goals.
• Create cases in the care management platform for each patient under care management with appropriate documentation including but not limited to: cognitive function, ADL, environmental factors, psychosocial, medical and benefits, etc.
• Has the understanding and ability to escalate when situations present and need additional leadership intervention.
• Develops and coordinates care plan and/or assessment findings with MSO/health plan care managers, as appropriate. Utilize available Health Information Systems (HIE) as available to maximize resources, information to help build a plan for each at-risk patient.
• Manages a case load of chronic and high-risk patients in collaboration with Medical Director, Director of Population Health and Care Management as well as respective MSO/IPA partners.
• Meets assigned / expected patient contacts daily to assess and coordinate care.
• Complies and measures performance indicators, trends and staff activity report relevant to CCSPIP, case management, disease management and other programs.
• Analyze and manage the review of high-cost claims and coding review.
• Develops workflows and processes to support care management operations.
• Develop the team objectives and goals with support to the organization and departmental strategic plans.
• Ensures compliance is maintained with all health plan, state, deferral, and accrediting agency standard, e.g., NCQA/CMS regulations/delegation.
• Expected to pursue ongoing education, certification, and self-development to remain current with industry standards and business objectives related to Care Management.

Required Qualifications:

• Current Licensure as a CA Registered Nurse required. Board Certified Nurse Practitioner (NP-BC) preferred.
• AHA Basic Life Support.
• AHA Advanced Cardiac Life Support
• Unencumbered California Registered Nurse (RN), with Graduate Degree in Nursing
• Seven (7) years of experience in an Acute Care, role, with at least three (3) years in a care management level role required
• Must have excellent verbal and written communication skills with fast paced problem-solving skills and the confidence to quickly implement resolutions.
• Have skills to independently utilize software such as Outlook, Word, Visio, Power Point, and Excel, as well as electronic health record documentation and research expertise.
• Must have fluency of standard care management and utilization screening tools such as MCG and InterQual. Interqual or MCG Certified Instructor preferred. Expertise in operationalizing and executing a Care Management Plan, hold a keen understanding of Daily Discharge Multi-Disciplinary Meetings, advanced experience with Allscripts Care Management tools, or other like management tools.
• Must hold experience with Care and Population Management & EMR Systems, such as, EPIC, Meditech, Cerner, Allscripts Care Management, knowledge of DRG, value based, risk based (capitation) and per diem payment methodologies.
• Must hold knowledge of all Federal, State and Local regulatory standards, have an advanced level knowledge of healthcare systems and applications to be able to successfully plan and coordinate activities and serve as a key resource to staff and others across the organization.
• Must have prior management experience in a large multi-entity healthcare organization preferred specifically in the Population Health arena.

Preferred Qualifications:

• Must have care management leadership and medical group/MSO care management experience preferrable in complex patient management, chronic care management and/or population health role.
• Previous Experience across multiple healthcare settings (in-patient acute care, ambulatory, and long-term care) preferred.

Hybrid LA County

Pay Rate: Min - $120,000 l Max - $165,000