Graduate of an accredited school of registered nursing.Â BSN preferred.
Five years+ clinical experience.Â Two years+ ambulatory case management or utilization review experience within the last three years.
Prefer of two (2) years+ experience in an HMO/IPA/Managed care setting is preferred and recommended.
Ability to work independently with minimal supervision, exercising judgment and initiative.Â Ability to manage multiple tasks with effective prioritization.Â Process oriented.Â Good computer skills.
Valid California Registered Nurse license. BCLS Required
CM and/or UM training and/or certification.Â Knowledge of CM standards, UM standards, clinical standards of care, NCQA requirements, CMS guidelines, Milliman guidelines, InterQual guidelines, and Medicaid/Medicare contracts and benefit systems is preferred.
Fire and Safety Certification.Â If no card upon hire, one must be obtained within 30 days of hire, and maintained by renewal before expiration date.Â
In collaboration with the interdisciplinary team, the Ambulatory Care Manager provides care coordination services evaluating options and services required to meet an individualâs health care needs to promote cost-effective, quality outcomes. Serves as a consultant to members of the health care team in the management of specific patient populations. The RN ambulatory care manager role integrates the functions of complex case management, utilization management, quality management, discharge planning assessment, and coordination of post-hospital care services, including transfers to an alternative level of care.As more complex medical treatment options emerge the Nurse Ambulatory Care Manager will look to eliminate gaps in the care provided, as well as needlessly duplicated treatment, all while controlling the cost of quality patient care. The Nurse Ambulatory Care Manager will leverage their clinical and social work experience to ring an understanding of the clinical process of assessment, planning, implementation, and evaluation to the process of case management.Some of the major duties of an ambulatory care management nurse include:â¢Documenting patientsâ case management plans and on-going activitiesâ¢Identifying patients âinsurance coverage or other sources of payment for servicesâ¢Identifying and addressing patient risk factors and/or obstacles to careâ¢Identifying patient needs, current services, and available resources, then connecting the patient to services and resources to meet established goalsâ¢Communicating the care preferences of patients, serving as their advocate, and verifying that interventions meet the patientâs needs and treatment goals. â¢Screening patients and/or population for healthcare needsâ¢Developing a patient-focused case management planâ¢Educating the patient/family/caregiver about the case management process and evaluating their understanding of the processSome of the major duties of an ambulatory care management nurse overlap into inpatient duties including:â¢Concurrent review of all patients to validate that the appropriate patient status is assigned upon admission and prior to dischargeâ¢InterQual or MCG reviews are completed within 24 hours of admissionâ¢Observation patients are effectively care managed on a daily basisâ¢Facilitate throughput and timely discharges throughout inpatient level of care
USC’s Viterbi School of Engineering has been one of the economic engines in Southern California and a vital hub in the California economy. The technical innovations and ideas generated by the Viterbi faculty and research community have resulted in countless innovations, many becoming the foundations for new companies, products and services. The thousands of students graduating each year bring new ideas and vitality to companies in California and beyond. With an annual research budget exceeding $205M each year, more than 46 research centers and institutes, more than 180 faculty members, 7,800 students and over 60,000 impassioned alumni world-wide, the Viterbi School is addressing some of the world’s great challenges.