DaVita LVN, UM Care Manager in COSTA MESA, California

LVN, UM Care Manager

Description

DaVita Medical Group manages and operates medical groups and affiliated physician networks in California, Nevada, New Mexico, Florida, Colorado and Washington in its pursuit to deliver excellent-quality health care in a dignified and compassionate manner. As of June 30, 2016 DaVita Medical Group (formerly HealthCare Partners) provided integrated care management for approximately 760,000 patients. DaVita Medical Group’s leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu.

We are committed to bringing the benefits of coordinated care to our patients and to taking a leading role in the transformation of the national healthcare delivery system to assure quality, access, and affordable care for all.

If you're looking to make a difference with a large, financially stable, well-recognized medical group, DaVita Medical Group may be the employer for you.

OVERVIEW OF POSITION

Under thedirection of a registered Nurse, this position is responsible for ensuring thecontinuity of care in both the inpatient and outpatient setting utilizing theappropriate resources within the parameters of established contracts andpatients’ health plan benefits. Facilitates continuum of patients’ care utilizing basic nursing knowledge,experience and skills to ensure appropriate utilization of resources andpatient quality outcomes. Performs caremanagement functions on-site or telephonically as the need arises. Reports findings to the Care Managementdepartment Supervisor / Manager / Director in a timely manner.

ESSENTIAL FUNCTIONS:

  • Consistently exhibits behavior and communicationskills that demonstrate HealthCare Partners’ (HCP) commitment to superiorcustomer service, including quality, care and concern with each and everyinternal and external customer.

  • Implements current policies and procedures set bythe Care Management department.

  • Conducts on-site or telephonic prospective,concurrent and retrospective review of active patient care, includingout-of-area and transplant.

  • Reviews patients’ clinical records of acuteinpatient assignment within 24 hours of notification.

  • Reviews patients’ clinical records within 48 hoursof SNF admission.

  • Reviews patient referrals within the specified caremanagement policy timeframe (Type and Timeline Policy).

  • Coordinates treatment plans and dischargeexpectations. Discusses DPA and DNRstatus with attending physician when applicable.

  • Prioritizes patient care needs. Meets with patients, patients’ family andcaregivers as needed to discuss care and treatment plan.

  • Acts as patient care liaison and initiatespre-admission discharge planning by screening for patients who are high-risk,fragile or scheduled for procedures that may require caregiver assistance,placement or home health follow-up.

  • Identifies and assists with the follow-up ofhigh-risk patients in acute care settings, skilled nursing facilities,custodial and ambulatory settings. Consultswith physician and other team members to ensure that care plan is successfullyimplemented.

  • Coordinates provisions for discharge fromfacilities including follow-up appointments, home health, social services,transportation, etc., in order to maintain continuity of care.

  • Communicates authorization or denial of services toappropriate parties. Communication mayinclude patient (or agent), attending/referring physician, facilityadministration and HCP claims as necessary.

  • Attends all assigned Care Management Committeemeetings and reports on patient status a defined by the region.

  • Demonstrates a thorough understanding of the costconsequences resulting from care management decisions through utilization ofappropriate reports such as Health Plan Eligibility and Benefits, Division ofResponsibility (DOR), and Bed Days.

  • Ensures appropriate utilization of medicalfacilities and services within the parameters of the patients’ benefits and/orCMC decisions. This includes appropriateand timely movement of patients through the various levels of care.

  • Maintains effective communication with the healthplans, physicians, hospitals, extended care facilities, patients and families.

  • Provides accurate information to patients andfamilies regarding health plan benefits, community resources, specialty referralsand other related issues.

  • Initiates data entry into IS systems of allpatients within the parameters of Care Management policies and procedures. Maintains accurate and complete documentationof care rendered including LOC, CPT code, ICD-9, referral type, date, etc.

  • Follows patients on ambulatory care managementprograms, including CHF and home health, in order to optimize clinicaloutcomes.

  • Uses, protects, and discloses HCP patients’protected health information (PHI) only in accordance with Health InsurancePortability and Accountability Act (HIPAA) standards.

  • Performs additional duties as assigned.

Qualifications

EDUCATION:

  • 1 or 2 years of post-high school education or adegree from a two-year college.

  • Graduation from an accredited school of Nursing.

  • Current California LVN license.

EXPERIENCE:

Minimum:

  • Over 1 year and up to and including 3 years of clinicalexperience.

  • At least 1 year of recent clinical experience.

Preferred:

  • 3 to 5 years of recent clinical nursing experience.

  • Previous care management, utilization review ordischarge planning experience.

  • Managed care experience.

KNOWLEDGE, SKILLS, ABILITIES:

  • Computer literate.

  • Knowledge of current standards of patient care.

  • Thorough understanding of LVN scope of practice.

  • Manual dexterity to use/handle equipment andinstruments.

  • Ability to effectively communicate and collaboratewith physicians, patients, families and ancillary staff.

  • Ability to make sound, independent judgments andact professionally under pressure.

Primary Location CA-COSTA MESA - 92626

Req ID: 301608