St. Joseph Health / Covenant Health Care Manager RN - Care Management in Mission Viejo, California
We are looking for a Care Manager Registered Nurse with the Care Management - MV Department at Mission Hospital Regional Medical Center.
Location: Mission Viejo, California
Work Schedule: On Call / Per Diem
Shift: 8-hour, Days
Care Management is a collaborative practice model including the patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The care management process encompasses excellent communication, both verbal and written, and facilitates care along a continuum through effective resource coordination.
The goal of the Care Manager is to advocate for and assist the patient in the achievement of optimal health, access to care, and appropriately utilizing resources. The Care Manager utilizes the following processes to meet the patient's individual healthcare needs: assessment, planning, implementation, coordination, monitoring and evaluation of the plan of care.
Assessment: The Care Manager will collect in-depth information about a persons’ situation and functional status to identify individual needs in order to develop a comprehensive plan of care that will address the patient’s needs. The Care Manager will identify both present and possible future needs of the patient and family, which may affect the plan of care and the patient’s well-being. This assessment will include age-specific physical, psychosocial, environmental, financial, and health status expectations.
Planning: The Care Manager will identify specific objectives, goals and actions, as identified during the assessment process. Acting as a patient advocate the Care Manager will collaborate with the physician, the patient and family, and members of the healthcare team, to formulate a shared plan of care. Goals and time frames for goals, appropriate to the patient, will be set.
Implementation: Executes specific interventions that will lead to accomplishing the goals and time frames of the shared plan of care. Works effectively with the healthcare team to determine the necessary steps to achieve the plan of care. Problem solving techniques will be applied to the implementation process. The Care Manager will utilize knowledge of alternative funding sources, benefit plans, and contractual information to promote appropriate quality, cost effective care for members throughout the healthcare continuum.
Coordination: Organizes, coordinates, provides, modifies or obtains appropriate authorizations, utilizing appropriate utilization review and evidence of coverage guidelines, to accomplish the patient’s goals. Initiates and communicates with the patient and family, physicians, healthcare members, and community and payor representatives. Facilitates continuity of care throughout all access points involving Health Plan, discharge planners, physicians and other appropriate staff.
Monitoring: Obtains sufficient information from all relevant resources in order to determine the effectiveness of the plan of care, and services provided. Manages a caseload of high risk, complex needs and/or catastrophic patients.
Evaluation: At appropriate and repeated intervals, assesses and reassesses the patients’ progress. If progress is static or regressive, determines the reason and encourages the appropriate interventions to obtain optimal outcomes. The Care Manager will modify the plan of care, as necessary, in coordination with the healthcare team, family members, and providers.
Communication: Communicates both verbally and electronically with the patient and the healthcare team. Appropriately documents the plan of care, outcomes, statistical reporting, logs, and files abiding to departmental, legal and regulatory requirements.
Knowledge of managed care principles, utilization management, case management and healthcare provided throughout the continuum.
Knowledge of physical and psychological characteristics of disease processes, recognizes potential clinical problems, and recommends intervention in a preventative, pro-active way.
Excellent interpersonal, verbal and written communication skills.
Ability to problem-solve.
Ability to access and evaluate community resources to meet patient’s needs.
Ability to handle multiple tasks at a time and remain organized.
Ability to work autonomously but demonstrates the ability to work collaboratively on a team.
Ability to work in an ambiguous environment; work effectively under pressure due to changes in priorities.
Excellent computer and IT system knowledge.
Knowledge and skills necessary to communicate with third party payers.
Establishes and maintains a good rapport with physicians and interacts well with all internal and external customers in a professional and courteous manner.
Basic computer skills including Windows, Microsoft Word, internet navigation and an e-mail system.
Preferred: Proficiency in Milliman Care Guidelines.
Minimum Position Requirements:
Education: Graduate of an accredited school of nursing.
Experience: 3 years Clinical experience in an HMO, medical group, affiliated model, hospital or medical office/clinic setting.
Licenses / Certifications: Current California Registered Nurse license.
Preferred Position Requirements:
Education: Bachelor of Science in Nursing (BSN) or Master’s in a related field
3 years experience in utilization management or case management.
Managed care experience.
Licenses / Certifications:
Certification in Case Management (CCM, ACM).
Specialty Certification in Oncology, Rehab, Pediatrics, Transplant, or Wound Care.
At Mission Hospital with locations in Mission Viejo and Laguna Beach, CA our core values of Compassion, Dignity, Justice, Excellence and Integrity translate into an environment where the welfare of our patients always comes before the bottom line. As a member of Providence Health System, we serve all of south Orange County.Mission Hospital Mission Viejo is a Level II Trauma Center and is the area's designated regional trauma center. We have Centers of Excellence in heart, maternity, trauma, breast care, spine, vascular, stroke and brain injury.Mission Hospital Laguna Beach provides local coastal communities with 24-hour emergency department services, medical/surgical services, behavioral health programs including inpatient and outpatient psychiatric and chemical dependency services and an outpatient eating disorder program.Mission Surgery Center performs approximately 4,500 annual surgeries and provides a safe and convenient outpatient setting. It is accredited by the Accreditation Association of Ambulatory Health Care.We've received two Beacon Awards for clinical excellence and in 2012 we received Magnet Designation which recognizes hospitals for top patient care, quality nursing and innovations in nursing and healthcare. We offer a collegial work environment with competitive salaries and benefits.Mission Hospital provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Mission Hospital complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.Positions specified as “on call/per diem” refers to employment consisting of shifts scheduled on as “as needed basis” to fill in for staff vacancies.
Company: Mission Hospital Regional Medical Center
Category: Case Management
Req ID: R326446
St. Joseph Health / Covenant Health
- St. Joseph Health / Covenant Health Jobs