The RN Lead Case Manager must have a demonstrated proficiency in the Ambulatory Care Manager duties described below:
Care manager makes an outreach call within 48 hours of referral and initiates and/or completes ACM assessment and care-plan.
Complete assessment for current/past medical conditions with dates of diagnosis, psychosocial issues, medications, ADL's, pain assessment, assess for advance directive/POLST/DPOA, cultural/linguistic needs, mental status, fall risk assessment, depression screening, available benefits, member/caregiver goals, degree of involvement, and resources; barriers to treatment - in both Access Express and the web module.
Consults with assigned PCP's frequently to discuss new referrals and to discuss the status of the enrolled patients.
Enter and update all authorization and clinical information into Nautilus (Access Express)
Authorize all appropriate services based upon covered benefits and necessity of care provided in the:
Member's home or residence
Authorization of SNF placement if patient is coming from home
Monitoring of continued appropriateness of the services rendered i.e. home health, DME, outpatient therapy.
Work in conjunction with the MSW on alternate housing placement if needed and to notify SNF CM of SNF admission.
Proper hand off with appropriate ISP CM when ACM enrolled patients are admitted to CSMC.
Ambulatory case managers will contact the patients telephonically shortly after discharge or may sometimes meet with them in their respective doctors' offices
Case Manager will wear appropriate CSMNS employee badge: all rules and policies of the facility will be followed while on-site.
Make referrals to supportive care services program, and NP House Call Programs, as appropriate.
Coordinate any services requested by supportive care services or NP House Call Programs.
Coordinate referrals and secure appointment with various CSMNS disease management programs such as anticoagulation clinic, Asthma, Diabetes, Hepatitis C, smoking cessation, cardiovascular risk reduction and nutrition, as appropriate.
In addition, the Lead Care Manager is expected to be able to:
Conduct documentation audits
Respond to sick calls and unscheduled absences and adjust staffing accordingly
Arrange and adjust contingency schedules for vacations, unscheduled days off, staffing crises
Function as the contact person for clinical issues and workflow processes for staff
Monitor ACM Management Dashboard in CS Link for new patient referrals, overdue goals, and overdue follow ups.
Maintain the ACM vision board updates
Monitor the hospitalizations of the patients enrolled into ACM and maintain logs.
Assist with training new hires
Participate in projects and initiatives as approved by the manager or director
Provide oversight to colleagues to ensure assistance is provided when needed
Function as a triage/resource to MDN Ambulatory Case Management operations.
Process Continuity of Care (COC) request's
Provide oversight to the TCM and CJR programs
Provide training/in-services as needed to the team i.e. ambulatory care management updates, managed care updates, CMS update, etc.
Provide mentoring and disciplinary guidance to staff regularly and as needed.
Present ACM workflows and processes to our Care Coordination for our new staff members for MDN
Demonstrates behavior, which supports the Cedars-Sinai Health System mission.
Attends required orientation and training seminars.
Meets production standards within established time requirements.
Work product and performance meets quality standards.
Demonstrates respect and positive interpersonal skills with patients, clients, the public, managers, and co-workers--a team player.
Maintains confidentiality of patient care and business matters.
Observes time, attendance, and dress code standards.
Protects the safety of others and of the physical environment and equipment, following institution policies, fire, safety and infection control regulations.
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research... and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major teaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.