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
Internal Number: REQ20081497
USC is the leading private research university in Los Angeles—a global center for arts, technology and international business. With more than 47,500 students, we are located primarily in Los Angeles but also in various US and global satellite locations. As the largest private employer in Los Angeles, responsible for $8 billion annually in economic activity in the region, we offer the opportunity to work in a dynamic and diverse environment, in careers that span a broad spectrum of talents and skills across a variety of academic and professional schools and administrative units. As a USC employee and member of the Trojan Family—the faculty, staff, students, and alumni who make USC a great place to work—you will enjoy excellent benefits, including a variety of well-being programs designed to help individuals achieve work-life balance.
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