Job description
SNF HMO CASE MANAGER JOB DESCRIPTION
The HMO Case Manager is responsible for the assessment, treatment planning, intervention, monitoring and evaluation of our residents who are health maintenance organization members. This position will assess and develop a care plan in collaboration with the admitting, attending and consulting physician and other health care practitioners to ensure that the appropriate level-of-care is provided, to prevent inpatient re-admissions and ensure that the residents’ medical, environmental and psychosocial needs are met during their stay.
1. Keeps patient/family members or other customers informed and requests if necessary, further assistance when needed.
2. Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
4. Functions as liaison between administration, patients, physicians and other healthcare providers.
5. Interacts professionally with patient/family/physicians and involves patient/family/physicians in formation of the plan of care.
6. Communicates appropriately and clearly to management, co-workers, and physicians
7. Identifies and addresses psychosocial needs of the patients and family and facilitates consultations with Social Worker, as necessary.
8. Receives and reviews physician’s orders; documents completion. Follows, consults with other departments as appropriate to provide for an interdisciplinary approach to the patients need.
9. Formulates an outcome-based plan or care, based on assessed patient needs, implements and evaluates plan as evidenced by documentation.
10. Maintains quality monitors as assigned by supervisor.
11. Documents patient assessment and reassessment, patient care plans, and other pertinent information completed in the patient’s medical record in accordance with nursing standards and policies.
12. Identifies community resources to address needs to cover through patient’s benefit plans.
14. Responsible for the coordination and facilitation of patient and family conferences as determined by assessment of patients’ needs.
15. Responsible for the coordination of clinic appointments, medication reconciliation, PCP and SPC visits.
17. Collaborates and communicates with all members of the interdisciplinary team to coordinate care and develop plans for management of each case.
18. Responsible for the identifying patients who are appropriate for hospice or Palliative care.
19. May also be responsible for co-management and discharge planning including regulatory compliance requirements and coverage notices.
20. Other duties as assigned.
Qualifications:
1. Graduate from an accredited Registered Nursing Program or Licensed Practical Nursing program.
2. Current CA RN or LVN license, current CPR certification, valid CA Driver’s License.
3. 3 years acute care experience.
4. 2-3 years of utilization or HMO experience preferred.
5. Typing 40 words per minute with accuracy.
6. Knowledge of computers, faxes, printers and all other office equipment.
7. Knowledge in MS Office Programs (ie Word, Excel, Outlook, Access and PowerPoint.
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Employee discount
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Ability to commute/relocate:
- Huntington Beach, CA 92648: Reliably commute or planning to relocate before starting work (Required)
Work Location: One location
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