Dignity Health

  • RN Care Coordinator

    Job ID
    2018-68791
    Employment Type
    Full Time
    Department
    Case Management
    Hours / Pay Period
    80
    Facility
    Dignity Health Management Services Organization
    Shift
    Day
    Location
    Redlands
    State/Province
    CA
    Standard Hours
    Mon-Fri (8-5 PM)
    Work Schedule
    8 Hour
  • Overview

    The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

     

    Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

     

    • This position will report to the: Manager, of Care Management
    • Percentage Travel Required/Frequency: 10%
    • FLSA Status: Non-Exempt
    • Remote Worker: Non-eligible

    Responsibilities

    Conducts medical necessity, level of care, and benefit reviews rendered in the inpatient and outpatient setting to ensure the patient receives the highest level of care. Coordinates with providers, provider staff, hospital staff, patients and patient family members to establish the appropriate level of care.

     

    1. Responsible for meeting all of the DHMSO Job Standards described below.
    2. Plans for and ensures that all post discharge care is coordinated appropriately according to the needs of the patient and ensures continuity of care.
    3. Conducts prior authorization review on all services that require nurse review.
    4. Travels to various hospitals within established areas to conduct patient visits.
    5. Conducts inpatient and skilled nursing facility level-of-care review on a concurrent basis.
    6. Plans for and coordinates all discharges from inpatient and skilled nursing facilities.
    7. Makes outbound calls to patients according to case management queue assignment and case management policies and procedures.
    8. Tracks barriers to appropriate inpatient and SNF utilization according to policy and procedure.

    Attends Utilization Management and/or Quality Management meetings as needed

    Qualifications

    What We’re Looking For

    1. Willingness to work as part of a team, working collaboratively with others to achieve goals, solve problems, and meet established organizational objectives and management of patients.
    2. Excellent communication skills; able to read, write, and speak articulately, using established channels of communication and reporting relationships within the organization. Ability to communicate effectively with all levels of internal/external staff, management, members, physicians/physician office staff, families of members, outside agencies, etc.
    3. General knowledge of Microsoft Office applications; Excel, Word, Outlook; experience with DHMSOOnline, QNXT.
    4. Ability to handle various situations in a professional manner, demonstrating excellent customer service at all times.
    5. Ability to demonstrate respect for the feelings and needs of patients, family members, team members, visitors, and others and sensitivity to their cultural, language, financial, physical, and social differences.
    6. Strong problem-solving abilities. Ability to identify issues and problems within administrative processes, activities, and other relevant areas.
    7. Ability to continually re-prioritize to meet the needs of internal and external customers throughout the workday. Ability to adapt to change quickly.
    8. Must be attentive to detail, accurate, thorough, and persistent in following through to completion of all activities, demonstrating initiative for completing work assignments.
    9. Must be able to travel to locations within the local areas. May require travel out of town which may include overnight stays.
    10. Ability to use the following general office equipment correctly and safely: desktop computer for data entry and typing, copy machine, scanner and facsimile machine, and of telephone equipment
    11. Ability to be reliable in attendance and timeliness to work schedules.
    12. Ability to adhere to dress code, good grooming, and personal hygiene habits.
    13. Ability to maintain knowledge of and conform to company policies and procedures.
    14. Ability to maintain strict confidentiality at all times.

    Minimum Qualifications:

    1. Graduation from an accredited CA Registered Nursing Program and current license required.
    2. Valid California Driver’s license, current DMV printout and insurance required.
    3. Must meet hospital credentialing requirements to obtain facility ID.

    Additional Required Qualifications:

    1. Knowledge of nursing processes, case management and continuity of care.
    2. Familiar with regulatory requirements for managed care, HMO’s and EPO’s.
    3. Ability to apply criteria to identify appropriate level of care on all admissions and clearly document any research conducted and rationale of decisions made.  Ability to identify care needs across the age continuum and according to principles of growth and development over the life span.
    4. Ability to apply appropriate business rules, medical guidelines and/or health plan benefits to authorization decision making.
    5. Proficiency with health plan criteria/benefits and regulatory requirements as they relate to patient management across the continuum of care.
    6. Proficient with standardized criteria, Interqual, MCG, Medicare, etc.
    7. Knowledge of network and benefit limitations and ability to collaborate with stakeholders to find alternatives that meet patient needs and achieve positive outcomes.
    8. Knowledge of disease management strategies
    9. Basic knowledge of CPT and ICD9/ICD10 coding.   
    1. People Leadership: Number of team members reporting directly to this role
    2. Physical Agility (if pertinent)
    3. Performs other duties and/or responsibilities as requested.
    4. Include all qualifications that one must have in order to be hired.
    5. Anything listed in this section must be measurable and objective. 
    6. Include all other qualifications that are required to be hired.
    7. These can be subjective and do not have to be measurable.

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