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Posted: Wednesday, November 15, 2017 4:11 AM

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

We currently have an opening for Peds/CCS Case Manager:

The Peds/CCS CM is responsible for the assessment, planning, intervention, monitoring and evaluating of all Pediatric members who are eligible for CCS benefits. The goal of the Peds/CCS CM is to effectively coordinate the care coordination needs of the member including collaborating with the Interdisciplinary Care Team, the member and the family. The Peds/CCS CM delivers case management services that are patient centered and assist the member and the family to achieve optimum health outcomes throughout the care continuum.

1. Establishes and maintains a relationship with the member and the family where the CM prioritizes and addresses the medical, social, functional, and psychosocial needs of the member.
2. Coordinate member/family/caregiver teaching, referrals and follow-up care for CCS members and work with the team to assist CCS eligible members to obtain coverage as needed.
3. Demonstrate knowledge and understanding on the limited resources for this population, the uniqueness of the member s social support and family dynamics in order to address the needs of the member.
4. Documents member assessment and reassessment, individualized care plans, and other pertinent information completed in the member s medical record in accordance with nursing standards, and company policies and procedures
5. Develops an outcome-based plan of care, based on the Member s input, HRA, medical records and assessment of member needs. Implements and evaluates the plan of care as often as needed as evidenced by documentation in the Member s case file.
6. Identifies the appropriate members to participate in the interdisciplinary case round (ICT) process. Prepares the necessary summary information to present to the team. Invites the Member, and at Member s discretion, caregiver and/or family, to attend ICT meeting when convened.
7. Communicates the Care Coordination process to Member/family/physicians and other Care Coordination team members explaining Member s right to refuse care coordination and accept as desired and the benefits of the program to the Member/family/physicians at no cost to the Member.
8. Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
9. Functions as care coordinator between Member, primary care provider, and multidisciplinary care team.
10. Demonstrates the ability to advocate for member and the family to meet the needs of the member.
11. Educates the member/caregiver on the transition process and how to reduce unplanned transitions of care.
12. Manages transition of care from the sending to receiving settings ensuring that the Plan of Care moves with the member and updates/modifies the care plan as the member s health care status changes.
13. Addresses psychosocial needs of the members and family and makes appropriate referral to Interdisciplinary Care Team members as needed.
14. Collaborates and communicates with all members of the healthcare team (concurrent review, pre-authorization, PCP/SPC, Social Services) to coordinate the continuum of care of developing plans for management of each case.
15. Responsible for the coordination of post-discharge clinic appointments, medication reconciliation, PCP and SPC visits, transportation and communication assistance
16. Identifies community resources to address needs based on assessment and makes appropriate referrals to appropriate resource.
17. Initiates home or hospital visits/rounds as needed to assess patient progress and meet with appropriate members of the patient care team
18. Ability to identify CCS covered benefits and direct members to utilize appropriate provider and receive timely care.
19. Other duties as assigned

Graduate from an accredited Registered Nursing Program or Licensed Vocational Nursing Program

Current CA RN, or LVN license, current CPR certification, valid CA Driver s license

1. At least 2-3 years of Pediatric acute care experience.
2. Knowledge of Medi-Cal and CCS programs preferred but not required.
3. Case Management experience preferred
4. Microsoft Word, Excel, Outlook and Vizio experience.
5. Strong Verbal, written and communication skills.
6. Detail oriented.

We offer a full benefits package which includes employer paid medical, pharmacy and 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 criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Associated topics: lead, licensed, lvn, lvn lpn, nurse i, nurse iv, pediatrics, practical nurse, practical nurse lpn, vocational nurse


• Location: Northridge, San Fernando Valley

• Post ID: 148864482 sanfernandovalley is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2017