RN Case Manager Team Lead Job at North American Staffing Group
Medica Talent Group is excited to share this direct-hire opportunity with you!
Our client, a well-known and reputable Managed Care Organization in the Los Angeles County area is seeking an RN Case Manager Team Lead to join their growing team. This is a wonderful opportunity for an individual seeking to expand their knowledge in the Managed Care arena. This organization offers competitive salary, full benefits and much more!
Please note that this position will require floating to different PACE locations in the LA County area. The RN case manager will be stationed at a PACE center for 2 to 3 months a time and then switch to a different one.
The Program of All-Inclusive Care for the Elderly, or PACE, was established by Medicare to help independent seniors with complex medical needs. The program helps participants avoid nursing homes and instead, receive the care and services necessary to help them stay safe, comfortable, and healthy living in their own home.
Job Summary:
The Team Lead Nurse Case Manager may provide daily care coordination, case management, coaching, consultation and intervention to patients with one or more chronic diseases while overseeing a team of Case Managers. May also be responsible for identifying said population via provider/clinic referral, utilization management referral, disease registry reporting mechanisms and patient self-referral. This position may also provide case management to patients who are admitted to the hospital and those patients who may need to be enrolled in ambulatory case management. The case manager will be responsible for identifying (California Children Services) CCS cases, handle transfers, and retro reviews. Works as part of an interdisciplinary care team coordinating social work and mental health counseling, psycho-social support services, in-home support, legal services, skilled nursing, home health, etc. The Team Lead Nurse Case Manager effectively collaborates with the hospitalist, the hospital nursing personnel, with members of the interdisciplinary care team and with the physician in the clinic. Additionally, the Team Lead Nurse Case Manager will be responsible for providing leadership and direction to a team of Case Managers.
Responsibilities:
Responsible for daily concurrent reviews, retro reviews, discharge planning, and ensures patients meet appropriate level of care based on acceptable evidence-based Clinical Criteria(s).Effectively and efficiently manages patients throughout the continuum of care. Works collaboratively with Hospitalists, hospital partners, and care teams to provide holistic patient care that is focused on high quality in a cost effective way. Will participate in the developing of all program material, Policies and Procedures related to the nurse case management program; may also develop program informational and educational materials and various forms. Develops a working relationship with the hospital case managers, health plan, clinics, hospitalists and other governing entities. Identifies and enrolls patients into a case management program providing intensive service. Conducts intakes and comprehensive assessments per health plan and department’s policy. Identifies needs and develops individualized care service plans on behalf of clients; an active participant in case conferences; attends divisional coordinators meetings and regular staff meetings; re-evaluates patients as needed; monitors the services delivered by team participants. Works with hospital discharge planners and assists in the coordination of support services. Attends Joint Operation Committee (JOC) meetings and various community meetings as needed. Responsible for the daily review and processing of referral authorizations in accordance to turnaround time (TAT) standards set by ICE/Health Plan requirements. Assist with composing medical director denials to meet language requirements set by ICE/Health Plan requirements. Perform and document patient telephonic and/or person-to-person risk assessments as needed. Monitor ongoing services and their cost effectiveness; recommending changes to the plan as needed using clinical evidence-based criteria — Milliman, Interqual, CMS, National Recognized American Academy of Specific Specialty. Performs other related duties as assigned.
INDMED
Please Note :
www.epokagency.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, www.epokagency.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.
Our client, a well-known and reputable Managed Care Organization in the Los Angeles County area is seeking an RN Case Manager Team Lead to join their growing team. This is a wonderful opportunity for an individual seeking to expand their knowledge in the Managed Care arena. This organization offers competitive salary, full benefits and much more!
Please note that this position will require floating to different PACE locations in the LA County area. The RN case manager will be stationed at a PACE center for 2 to 3 months a time and then switch to a different one.
The Program of All-Inclusive Care for the Elderly, or PACE, was established by Medicare to help independent seniors with complex medical needs. The program helps participants avoid nursing homes and instead, receive the care and services necessary to help them stay safe, comfortable, and healthy living in their own home.
Job Summary:
The Team Lead Nurse Case Manager may provide daily care coordination, case management, coaching, consultation and intervention to patients with one or more chronic diseases while overseeing a team of Case Managers. May also be responsible for identifying said population via provider/clinic referral, utilization management referral, disease registry reporting mechanisms and patient self-referral. This position may also provide case management to patients who are admitted to the hospital and those patients who may need to be enrolled in ambulatory case management. The case manager will be responsible for identifying (California Children Services) CCS cases, handle transfers, and retro reviews. Works as part of an interdisciplinary care team coordinating social work and mental health counseling, psycho-social support services, in-home support, legal services, skilled nursing, home health, etc. The Team Lead Nurse Case Manager effectively collaborates with the hospitalist, the hospital nursing personnel, with members of the interdisciplinary care team and with the physician in the clinic. Additionally, the Team Lead Nurse Case Manager will be responsible for providing leadership and direction to a team of Case Managers.
Responsibilities:
Responsible for daily concurrent reviews, retro reviews, discharge planning, and ensures patients meet appropriate level of care based on acceptable evidence-based Clinical Criteria(s).Effectively and efficiently manages patients throughout the continuum of care. Works collaboratively with Hospitalists, hospital partners, and care teams to provide holistic patient care that is focused on high quality in a cost effective way. Will participate in the developing of all program material, Policies and Procedures related to the nurse case management program; may also develop program informational and educational materials and various forms. Develops a working relationship with the hospital case managers, health plan, clinics, hospitalists and other governing entities. Identifies and enrolls patients into a case management program providing intensive service. Conducts intakes and comprehensive assessments per health plan and department’s policy. Identifies needs and develops individualized care service plans on behalf of clients; an active participant in case conferences; attends divisional coordinators meetings and regular staff meetings; re-evaluates patients as needed; monitors the services delivered by team participants. Works with hospital discharge planners and assists in the coordination of support services. Attends Joint Operation Committee (JOC) meetings and various community meetings as needed. Responsible for the daily review and processing of referral authorizations in accordance to turnaround time (TAT) standards set by ICE/Health Plan requirements. Assist with composing medical director denials to meet language requirements set by ICE/Health Plan requirements. Perform and document patient telephonic and/or person-to-person risk assessments as needed. Monitor ongoing services and their cost effectiveness; recommending changes to the plan as needed using clinical evidence-based criteria — Milliman, Interqual, CMS, National Recognized American Academy of Specific Specialty. Performs other related duties as assigned.
INDMED
Please Note :
www.epokagency.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, www.epokagency.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.