RN, Case Manager

Title: RN, Case Manager

Location: Fountain Valley

Department: Medical Management

Status: Full-time

Shift: Day

Pay Range*: $48.45/hour - $70.29/hour 

Bonus: $10,000

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

Under minimal supervision and in a professional and friendly manner, perform assigned job duties to the highest level of customer service and assistance to both internal and external customers of Memorial Care Medical Foundation Case Management unit.

Essential Functions and Responsibilities of the Job

1. Identifies and evaluates members for enrollment into one of the Memorial Care Medical Foundation Case Management programs (SPARK/IOCP, Complex, Care Coordination) through physician referral, utilization data, inpatient referral, predictive modeling software, health plan referral, patient and family referral, and other sources as they occur.
2. Carriescaseload mix as set by department manager to align with overall equity, acuity and organization goals.
3. Assesses, plans, implements, coordinates, monitors, and evaluates all options and services with the goal of optimizing and supporting the member’s health status and goals.
4. Adheres toCM Standards of Practice and uses evidence-based clinical treatment guidelines, preventive guidelines, protocols, and other metrics in the development of Care Plans and Shared Action Plans.
5. Monitors outcomes of the plan that are adherent to all regulatory requirements and are patient-centered, promoting efficiency and quality in the delivery of healthcare for the designated patient population.   Modifies the care plan based on patient needs/stated goals and per department’s productivity standards and quality measures.
6. Integrates evidence-based clinical treatment guidelines, preventive guidelines, protocols, and other metrics in the development of Care Plans and Shared Action Plans.
7. Develops care plans and monitors outcomes of the plan that are adherent to regulatory requirements and are patient-centered, promoting efficiency and quality in the delivery of healthcare for the designated patient population.   Modifies the care plan based on patient needs/stated goals and per department’s productivity standards and quality measures.
8. Works effectively with other members of the health care team and acts as liaison to optimize interventions.  Coordinates services with appropriate physicians, facilities, contracted providers, and ancillary providers (disease management, behavioral health, social services and community resources) as indicated.
9. Dedicated to the delivery of high-quality patient care and service, has a continuous learning approach to work, and finds opportunity in challenges and barriers.
10. Maintains comprehensive and confidential patient records in compliance with all HIPAA regulations and per documentation standards with the patient’s electronic medical record or other approved documentation system.
11. Supports the organization’s goals and mission statement and in a professional manner.
12. Attends and participates in appropriate Patient Care Conferences, committees or related meetings, providing comprehensive and accurate case management reports and documents as required.
13. “Other duties as assigned”

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Minimum Requirements

Qualifications/Work Experience:

1. Previous Case Management experience preferred
2. Work experience in Microsoft Word, Microsoft Excel and Microsoft Outlook required
3. Work experience applying evidence-based criteria (i.e.: MCG, lnterqual); Health plan medical policy / clinical coverage guidelines required
4. A minimum of two (2) years’ Clinical Nursing Experience in a hospital or like setting required
5. Knowledge of CMS (Centers for Medicare and Medicaid Services) coverage policies required
6. Previous and or ability to learn use of electronic medical record, UM/CM platforms or electronic health record preferred

Education/Licensure/Certification:

1. Current California Registered Nurse license (RN) required 
2. Associate's degree (AA) in nursing or equivalent from a two-year college or technical school required
3. Bachelor of Science in Nursing, or related field preferred
4. CCM preferred