Position Summary: The SNF Placement Team (SPT) Case Manager performs triage functions by providing support and guidance, to After Hours team by assisting with transferring patients from Acute setting to SNF, Sub-acute, Congregate Livings and/or Recuperative Care Centers. Afterhours SPT Case Manager responds to and coordinate service request for transfers, request for SNF/Sub-acute/Recuperative Care admissions and facilitate discharges to lower levels of care to prevent additional bed days in Acute and delay of transfers. Demonstrates self-direction in establishing priorities and working with routine supervision. Working collaboratively with After Hours SPT Coordinator and After Hours Team after business hours and weekends. Maintains high level of precision in judgment, accuracy of assessment, and skill in problem solving under stress. Relates and communicates well over the telephone to all callers.
Essential Duties and Responsibilities include the following: - Facilitates transition of members from Acute setting to Skilled Nursing
- Facilities, Sub-Acute Facilities, Congregate Livings and Recuperative Care Centers.
- Communicate with After Hours Inpatient team
- Clinical review of SNF placement requests and clinical progress notes
Receives, triages, and responds to telephone calls from facilities requiring medical and nursing inquiries - Performs comprehensive review of clinical records, history & physical, evaluation of Skilled need and advice while meeting production standards.
- Assesses patient problems utilizing approved MCG guidelines, directing access to care to include Skilled Nursing Facilities, Sub-acute Facilities, Congregate
- Livings and Recuperative Care Centers
- Follows established clinical protocols/guidelines
- Directs patient to appropriate levels of care based on assessment within the established guidelines.
- Communicates to After Hours Management and escalate issues as necessary
- Facilitates authorizations for vendors and/or outside services as appropriate.
- Obtain LOA for non-contracted facilities as needed
- Documents all calls according to established standards in REA/LEA
- Documents all SNF inquiries and member disposition in the SNF Placement Team log daily
- Participates in quality monitoring process by daily verbal endorsement between SNF Placement Team business hours and After Hours Team
- Translates oral information into concise and accurate written documentation using standard medical guidelines and abbreviations.
- Shift summary to be sent to the Director, Manager and Lead of SNF Department
- Recognizes financial, medical and legal risks based on data collected during customer interactions and follows appropriate procedures.
- Demonstrates customer service-oriented behavior at all times.
- Acts as a mentor as requested by supervisor.
- Expedites emergency calls as needed.
- Participates in regular staff meetings as scheduled.
- Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
- Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
- Performs additional duties as assigned.
- Adheres to Code of Conduct
The pay range for this position at commencement of employment is expected to be between $37.25 and $40.00 hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Full Time Position Benefits: The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness: - Employer-paid comprehensive medical, pharmacy, and dental for employees
- Vision insurance
- Zero co-payments for employed physician office visits
- Flexible Spending Account (FSA)
- Employer-Paid Life Insurance
- Employee Assistance Program (EAP)
- Behavioral Health Services
Savings and Retirement: - 401k Retirement Savings Plan
- Income Protection Insurance
Other Benefits: - Vacation Time
- Company celebrations
- Employee Assistance Program
- Employee Referral Bonus
- Tuition Reimbursement
- License Renewal CEU Cost Reimbursement Program
- Business-casual working environment
- Sick days
- Paid holidays
- Mileage
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
Education and/or Experience: Education :
- Graduate of an accredited nursing program
- Registered Nurse or Licensed Vocational Nurse licensed in California
- Current basic life support (BLS) certification
Experience :
- Minimum 3 years of clinical experience in a Skilled Nursing Facility setting
- 1 - 2 years Case Management experience. Managed care experience preferred
- High levels of experience or expertise in:
- Crisis intervention
- Teaching/coaching
- Disease management
- Discharge Planning
Skills - Good judgment and critical-thinking skill
- Compassionate and caring manner with patients
- Telephone "charisma"
- Forms instant rapport
- Customer service-oriented
- Helpful, warm, open, and inviting
- Excellent communication skills (written, verbal, and technical)
- Articulate
- Able to communicate well at fifth- to eighth-grade level
- Bilingual language skills a plus
