Top Provider Network Executive jobs in Los Angeles, CA

Position Summary:

The Inpatient Case Manager is responsible for the assessment, treatment planning, intervention,
monitoring, evaluation and documentation on identified patients during an acute care episode.
Assesses and develops a plan of care in collaboration with the admitting, attending and consultant
physicians, and other healthcare practitioners. The goal of the Inpatient Case Manager is to effectively
manage the patients during their hospitalization to assure the appropriate level of care is provided for
the patient’s current severity of illness, utilizing the appropriate tests and diagnostics, in the appropriate
facilities in order to provide the highest level of care, in the most efficient manner, while utilizing only
the resources necessary for that episode of care. The Inpatient Case Manager is also responsible for
developing a safe discharge plan and implementing the discharge plan for patients with the necessary
resources to ensure that care is provided without interruption along the continuum of care, whether in
a skilled nursing facility, assisted living facility, in the home setting, etc. The Inpatient Case Manager will
plan, coordinate, and collaborate with internal departments to ensure the patient is receiving the best
coordination of care. The Inpatient Case Manager will document based on regulatory and contractual
guidelines established by Federal, State, Local and Health plan guidelines, along with policies and
procedures established by the Medical Management department.

Essential Duties and Responsibilities include the following but are not limited to:

• Perform clinical review upon admission and daily while patient is hospitalized
• Assure appropriate level of inpatient care
• Monitor inpatient stay to prevent delays in services and/or report aberrancy’s.
• Identify and resolve barriers or potential barriers to safe transition and outpatient management.
• Coordinate and assure all services for care transitions including transfer to lower levels of care,
  transfer to outpatient management, etc.
• Educate members on post discharge instructions, outpatient physician follow‐up, appropriate
  use of urgent care, and appropriate use of ER services.
• Initiate and hand off case to Skilled Nursing Case Managers or Outpatient Management
• Programs (i.e. Vital Care, Hospice, etc) as appropriate.
• Timely response to member needs – act in the moment.
• Coordinate care for patients in the Emergency Room or Urgent Care to avoid an unnecessary actions.
• Timely documentation based on regulatory and contractual guidelines established by Federal,
  State, Local and Health plan guidelines, along with policies and procedures established by the
  Medical Management department.
• Creating and approving referrals for admissions and outpatient services based on Medical
  Management guidelines.
• Creating letters for patients based on regulatory and contractual guidelines established by
  Federal, State, Local and Health plan guidelines, along with policies and procedures established
  by the Medical Management department.
• 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.
• Seek assistance and escalate issues when needed from the Administrator on call, or Regional
  Medical Director on call for clinical oversight and decision making.
• Participate in weekend rounds with Regional Medical Director and Hospitalists.
• Perform other duties as assigned.

The pay range for this position at commencement of employment is expected to be between RN $45.00-$50.00 per hour; LVN $37.25-$40.00 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.