Job Title

Overview(Hybrid LA County) The CRC Chronic Care Manager for Population Health and Value Based Care will facilitate coordination, communication, and collaboration with patients/members, providers, ancillary services, and leadership to achieve goals and maximize patient/member outcomes through an innovative whole person chronic care strategy by working with CRC, Hospitals, MSOs and IPAs. Best practice focus will be placed on the provision of care in ambulatory care settings, efficient patient/member management through chronic care management and leadership escalation to ensure appropriate use, level of care and timeliness of services. The Chronic Care Manager for Population Health and Value Based Care will promote the vision and be responsible for the implementation of these strategic objectives.ResponsibilitiesThe Chronic Care Nurse Care Manager implements programs within assigned areas. Position requirements include thorough knowledge of the organization's policies, procedures, workflow, monitoring and oversight tools, employee relations, company goals and vision. 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 while maintaining focus on 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.The Chronic Care Nurse Care Manager must prioritize competing demands and promote a multidisciplinary team approach with strong problem-solving skills and attention to detail. Responsible for consistent operational compliance and reporting to satisfy and exceed state, federal and accrediting agency standards.Must have experience implementing new programs that support the management of patients with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent readmission. The Chronic Care Nurse Care Manager ensures that Members/' medical, environmental, and psychosocial needs are optimized through the continuum of care.Participates 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. Assists with daily clinical operations, compliance, and oversight of programs. Serves as liaison for operational teams 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 interventions, and provides coaching and guidance to the Clinical Management staff for effective operation of social services, community care and other chronic care management programs.Participates in 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 Interdisciplinary Rounds.Works collaboratively with Medical Director and Population Health and Care Management Director to ensure compliance, identify specialist issues, review readmissions 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 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 (NCQA and DMHC) for turnaround times 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. Develops patient-prioritized self-management goals.Creates cases in the care management platform for each patient under care management with appropriate documentation including cognitive function, ADL, environmental factors, psychosocial, medical and benefits, etc.Understands and has the 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. Utilizes available Health Information Systems (HIE) as available to maximize resources and information to help build a plan for each at-risk patient.Manages a caseload of chronic and high-risk patients in collaboration with Medical Director, Director of Population Health and Care Management and respective MSO/IPA partners.Meets assigned/expected patient contacts daily to assess and coordinate plies with and measures performance indicators, trends and staff activity reports relevant to CCSPIP, case management, disease management and other programs.Analyzes and manages the review of high-cost claims and coding review.Develops workflows and processes to support care management operations.Develops the team objectives and goals aligned with the organization and departmental strategic plans.Ensures compliance with all health plan, state, federal, and accrediting agency standards (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.QualificationsRequired 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.Ability to independently utilize software such as Outlook, Word, Visio, Power Point, and Excel, as well as electronic health record documentation and research expertise.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, with understanding of Daily Discharge Multidisciplinary Meetings and experience with Allscripts Care Management or similar tools.Experience with Care and Population Management & EMR Systems (e.g., EPIC, Meditech, Cerner, Allscripts Care Management), knowledge of DRG, value-based, risk-based (capitation) and per diem payment methodologies.Knowledge of all Federal, State and Local regulatory standards; advanced knowledge of healthcare systems and applications to coordinate activities and serve as a resource across the organization.Prior management experience in a large multi-entity healthcare organization, preferably in Population Health.Preferred Qualifications:Care management leadership and medical group/MSO care management experience preferable in complex patient management, chronic care management and/or population health roles.Experience across multiple healthcare settings (in-patient acute care, ambulatory, and long-term care) preferred.Hybrid LA CountyPay Rate: Min - $120,000 | Max - $165,000 #J-18808-Ljbffr