High Risk Case Manager (RN)

Position Summary:

Reporting to the Director of HROB and NICU Team. The Case Manager High Risk OB RN is directly responsible for the assessment, treatment planning, intervention, monitoring and coordination of inpatient NICU and Pediatric cases or High Risk OB outpatient case. The position is responsible for maximizing quality while effectively utilizing appropriate resources within the members' benefit plans and established contracts.

The Case Manager is responsible, along with other members of Medical Management Team, for contributing to the clinical, quality, financial and patient satisfaction outcomes of the company.

Essential Duties and Responsibilities include the following:

• Identifies and develops policies and procedures as it relates to the HROB/NICU programs
• Assists in overseeing compliance and consistency of the program that meets RMG and regulatory standards.
• Acts as resource for all clinical staff.
• Develops, monitors, and analyzes reports and identifies trends to improve the program outcomes.
• Participates in developing and coordinating strategies across the continuum of care for ensuring the delivery of care in the most cost effective setting.
• Provides daily reviews and updates to the Team on all NICU /Pediatric cases which includes level of care status and discharge plans.
• Works collaboratively with the entire Medical Management team to ensure compliance with regulatory and health plan requirements.
• Develop working relationships with hospital case management departments to facilitate timely reviews.
• Ensures “triage” of patients to the appropriate level of care and facility.
• Works closely with other departments (claims, finance, high risk, TOC) as
• Anticipates customer needs: Understand the wants and needs of customers, listen for cues and respond to the level of intervention
• Formulates an outcome-based plan or care, based on assessed patient needs, implements and evaluates plan as evidenced by
• Greets patients, family members, and physicians in a positive manner by introducing self, speaking clearly and with
• Assists others and supports the team.
• Follows through with requests, sharing of critical information, and getting back to individuals same day or within one (1) business
• Protects privacy for both patients and employees; ensures information sensitive papers, charts, and reports are not in view of the
• Treats patients and their families with respect and Identifies and addresses psychosocial, cultural, ethic, and religious/spiritual needs of patients and their families. Functions as liaison between administration, patients, physicians, and other healthcare providers.
• Interacts professionally with patient/family/providers and involve patient/family/providers as
• Communicates appropriately and clearly to management, co-workers, and
• Understands and applies principles of adult learning methods as they relate to health care educational
• Consults and collaborate with other departments as appropriate to provide for an interdisciplinary approach to the patient's
• Maintains quality monitors as determined by the Utilization Management and Quality Management Committees and RMG
• Documents appropriately pertinent information completely, in the in the authorization system according to nursing standards and
• Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.
• Other duties as directed by management.

The pay range for this position at commencement of employment is expected to be between $45 - $50 per 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:

• Graduate from an accredited Registered Nursing Program or License Vocational Program.
• Current California Licenses and car insurance required.
• Previous Case management experience preferred.
• High level knowledge of Concurrent Review/Case Management processes and principles.
• Ability to work with all levels of management.
• Excellent communications skills both verbally and written.
• Excellent organizational skills.
• Knowledge of computers, faxes, printers and all other equipment.
• Knowledgeable in MS Office Programs (i.e. Word, Excel, Outlook, Access and Power Point), NICU experience required.