Works collaboratively with an assigned panel of physicians to manage the patient's specialized needs. The managing team does differ according to the chronic disease. Duties include assessment to identify member needs and development of specific care management plan to address needs. In conjunction with the Physician, implements care/treatment plan by coordinating access to health services across multiple providers/ disciplines, monitors care, makes determination to arrange transportation and transfer patient if indicated, identifies cost-effective measures, makes recommendations for alternative levels of care and utilization of resources, promotes self-care management and ensures paper work is completed. Is an indirect caregiver. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team.
Evaluates and identifies members' needs. Interfaces with Primary Care Physicians, Specialists and various disciplines on the development of case management plans/programs.
Monitors and evaluates the effectiveness of the case management plans and modifies as necessary.
Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families.
Acts as a clinical liaison, per their specialty, with outside agencies such as County CCS, non-plan facilities, outside providers, employers and/or workers' compensation carriers and third party administrators.
Prepares reports, communicates program changes to appropriate staff and develops protocols in accordance with state regulations.
Acts as a patient advocate and educator to assure that the patient has the knowledge to care for his/her condition and patient is educated and empowered to be responsible for participating in the plan of care.
Develops individualized patient/family education plan focused on self-management, delivers patient/family education specific to a disease state.
Develops and updates training and educational materials and presents to appropriate staff, members and families. Facilitates patients' return to normal daily activities by teaching and making appropriate referrals for outside services/continued care.
Consults with internal and external physicians, health care providers, discharge planners, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
May need to facilitate transportation and housing arrangements for patient. Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
Participates in data collection and analysis of clinical outcomes of care and customer satisfaction standards. Participates in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service. Ensures that accurate records are maintained of the care associated with each patient.
Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers and outside agencies.
Minimum two (2) years of clinical experience as an RN in an acute care or ambulatory care setting required.
Cancer Program: Two (2) years clinical experience in Oncology.
For positions in OB/Gyn: (2) years recent (within the past three (3) years) clinical experience in Maternal Child Health, FCC, Ob/Gyn or Women's Health in acute care or ambulatory care.
Demonstrated knowledge of maternal/fetal medicine, including high risk pregnancies.
For positions in Neonatal Intensive Care Unit: Two (2) years clinical experience in a Level III NICU.
For positions in High Risk Infant Program: Two (2) years experience in a Regional or Community NICU; one (1) year of which should be in an HRIF program or as a discharge planner for an NICU and/or in a community-based Medically Vulnerable Infant Program.
This experience may have been at a comparable out-of-state facility. Case management of patients in a High Risk Infant Program. Ability to manage annual Synagis Clinic for at-risk population. Previous case management experience preferred (usually two (2) years chronic disease case management).
Total Joint Replacement Travel Surgery Program (OC): One (1) year clinical experience in Orthopedics.
Home Based Cardiac Rehab Program: One (1) year clinical experience in Cardiology.
Bachelor's degree or equivalent experience four (4) years required.
For positions in High Risk Infant Program: Bachelor's degree in nursing or related field required.
License, Certification, Registration
Current California RN license required.
Cancer Program: OCN required within one (1) year of hire.
High Risk Infant Program: Meet requirements to be a CCS paneled provider.
Regional Genetic Screening Program: BLS is not required.
Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of utilization review/management, care coordination, transfer coordination, discharge planning or case management.
Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking and problem-solving skills required.
Computer literacy skills required.
Cancer Program: Two (2) years experience in Ambulatory Oncology.
Total Joint Replacement Travel Surgery Program (OC): One(1) year experience in Total Joint Replacement.
Bachelor's degree in nursing or healthcare related field preferred.
For positions in High Risk Infant Program: Masters degree and PHN preferred.
Case Management Certification or certification in the area of specialty preferred.
What Information Do We Collect?
When you visit our website you may provide us with two types of information: personal information you knowingly choose to disclose that is collected on an individual basis and website use information collected on an aggregate basis as you and others browse our website.
Personal Information You Choose to Provide
We may request that you voluntarily supply us with personal information, including your email address, postal address, home or work telephone number and other personal information for such purposes as correspondence, placing an order, requesting an estimate, or participating in online surveys.
If you choose to correspond with us through email, we may retain the content of your email messages together with your email address and our responses. We provide the same protections for these electronic communications that we employ in the maintenance of information received by mail and telephone.
Website Use Information
Similar to other websites, our site may utilize a standard technology called "cookies" (see explanation below, "What Are Cookies?") and web server logs to collect information about how our website is used. Information gathered through cookies and server logs may include the date and time of visits, the pages viewed, time spent at our website, and the sites visited just before and just after ours. This information is collected on an aggregate basis. None of this information is associated with you as an individual.
How Do We Use the Information That You Provide to Us?
Broadly speaking, we use personal information for purposes of administering our business activities, providing service and support and making available other products and services to our customers and prospective customers. Occasionally, we may also use the information we collect to notify you about important changes to our website, new services and special offers we think you will find valuable. The lists used to send you product and service offers are developed and managed under our traditional standards designed to safeguard the security and privacy of all personal information provided by our users. You may at any time to notify us of your desire not to receive these offers.
What Are Cookies?
Cookies are a feature of web browser software that allows web servers to recognize the computer used to access a website. Cookies are small pieces of data that are stored by a user's web browser on the user's hard drive. Cookies can remember what information a user accesses on one web page to simplify subsequent interactions with that website by the same user or to use the information to streamline the user's transactions on related web pages. This makes it easier for a user to move from web page to web page and to complete commercial transactions over the Internet. Cookies should make your online experience easier and more personalized.
How Do We Use Information Collected From Cookies?
We use website browser software tools such as cookies and web server logs to gather information about our website users' browsing activities, in order to constantly improve our website and better serve our users. This information assists us to design and arrange our web pages in the most user-friendly manner and to continually improve our website to better meet the needs of our users and prospective users.
Cookies help us collect important business and technical statistics. The information in the cookies lets us trace the paths followed by users to our website as they move from one page to another. Web server logs allow us to count how many people visit our website and evaluate our website's visitor capacity. We do not use these technologies to capture your individual email address or any personally identifying information about you.
Notice of New Services and Changes
Occasionally, we may use the information we collect to notify you about important changes to our website, new services and special offers we think you will find valuable. As a user of our website, you will be given the opportunity to notify us of your desire not to receive these offers by clicking on a response box when you receive such an offer or by sending us an email request.
How Do We Secure Information Transmissions?
When you send confidential personal information to us on our website, a secure server software which we have licensed encrypts all information you input before it is sent to us. The information is scrambled en route and decoded once it reaches our website.
Other email that you may send to us may not be secure unless we advise you that security measures will be in place prior to your transmitting the information. For that reason, we ask that you do not send confidential information such as Social Security, credit card, or account numbers to us through an unsecured email.
How Do We Protect Your Information?
Information Security -- We utilize encryption/security software to safeguard the confidentiality of personal information we collect from unauthorized access or disclosure and accidental loss, alteration or destruction.
Evaluation of Information Protection Practices -- Periodically, our operations and business practices are reviewed for compliance with organization policies and procedures governing the security, confidentiality and quality of our information.
Employee Access, Training and Expectations -- Our organization values, ethical standards, policies and practices are committed to the protection of user information. In general, our business practices limit employee access to confidential information, and limit the use and disclosure of such information to authorized persons, processes and transactions.
How Can You Access and Correct Your Information?
You may request access to all your personally identifiable information that we collect online and maintain in our database by emailing us using the contact form provided to you within the site structure of our website.
Do We Disclose Information to Outside Parties?
What About Legally Compelled Disclosure of Information?
We may disclose information when legally compelled to do so, in other words, when we, in good faith, believe that the law requires it or for the protection of our legal rights.
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Automated Recurring Donation Cancellation
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