Lead Case Manager, LVN - Inpatient Specialty Programs

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A Little More About What You Will be Doing

The Lead Ambulatory Care Manager will assist in the daily operations of the ambulatory case management department. Primary responsibility is to support the Manager of Outpatient Care Management, regarding the daily functions of the Ambulatory Care Management Department. In collaboration with the CSMG, CSHA, CI Primary Care Physicians and specialists, the program is designed to assist patients at the time they are identified as a candidate for ACM in assessing patient's needs, coordinating care, communicating with health plans to determine benefits and referring to ancillary programs i.e., Disease Management, Nurse Practitioner House Call Program, Palliative Care.

Job duties and responsibilities:

• Handles outreach call within 24 hours of urgent referrals, 72 hours for routine referrals and initiates and or completes ACM assessment and care-plan.
• Completes assessment for current/past medical conditions with dates of diagnosis, psychosocial issues, medications, ADLs, pain assessment, assess for advance directive/POLST/DPOA, cultural/linguistic needs, mental status, depression screening, available benefits, member/caregiver goals, degree of involvement, and resources; barriers to treatment. Accurately document above assessment in CS-Link.
• Consults with assigned Primary Care Physicians, as needed, to discuss status of new referrals and to discuss the status/treatment plan of patients enrolled in ACM.
• Ensures managed care referrals are processed, per NCQA Guidelines, and appropriately documented in Access Express. Monitors of continued appropriateness of the services rendered i.e. home health, DME, outpatient therapy.
• Processes all appropriate services based upon covered benefits, health plan or Milliman Care Guidelines, or medical necessity
• Collaborates with social workers re: alternate housing or placement and notification of transfer SNF of ALF.
• Transitions of Care Hand-Off, to assigned ISP CM, when ACM patients are admitted to CSMC. Monitors the hospitalization of patients enrolled in ACM and maintain logs. Functions as the triage/resource to CSMNF Ambulatory Case Management operations.
• Contacts the patients telephonically, within 48 hours, post-discharge. Meets patient, at physician appointments, as necessary, to establish rapport with high risk individuals, or, when additional support is required.
• Refers high risk patients to Supportive Care Services Program, and NP House Call Programs, as appropriate.
• Coordinates and monitors referrals and secure appointment with various CSMNS Disease Management programs such as Anticoagulation Clinic, Asthma, Diabetes, Hepatitis C, Smoking Cessation, Cardiovascular Risk, as appropriate.
• Manages staffing schedule, Assists with training new hires; oversees projects and initiatives as assigned, conducts documentation audits.

Qualifications

Education:

• Associates degree or college diploma required
• Bachelor's degree preferred

License/Certifications:

• Valid CA LVN license required
• Certified Case Manager certification preferred

Experience:

• 3 years of LVN experience required
• 3 years of previous experience in case management in the acute inpatient or outpatient settings preferred; knowledge of HMO and Medicare rules in inpatient

Req ID : 11047
Working Title : Lead Case Manager, LVN - Inpatient Specialty Programs
Department : MNS ISP
Business Entity : Cedars-Sinai Medical Center
Job Category : Patient Services
Job Specialty : Case Management
Overtime Status : NONEXEMPT
Primary Shift : Day
Shift Duration : 8 hour
Base Pay : $49.66 - $79.46 Qualifications

Education:

• Associates degree or college diploma required
• Bachelor's degree preferred

License/Certifications:

• Valid CA LVN license required
• Certified Case Manager certification preferred

Experience:

• 3 years of LVN experience required
• 3 years of previous experience in case management in the acute inpatient or outpatient settings preferred; knowledge of HMO and Medicare rules in inpatient