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RN Care Manager - Permanent
Ref No.: 17-09604
Location: Orange, California
Start Date: 08/21/2017
RN Care Manager -Outpatient Care Coordination

Reporting to the leadership of Care Management and Social Services, in collaboration with the VP of Population Health, this position is responsible for the delivery of care coordination services for patients in the specialty clinics. The RN Care Manager is involved in the planning and delivery of family -centered patient care through a collaborative process including the patient and family, nurses, social workers, physicians, other practitioners, caregivers and the community. The Care Coordination process encompasses excellent communication, both verbal and written and facilitates care along the continuum. The goal of the Care Coordinator is to advocate for and assist in the achievement of optimal health, access to care, and to utilize the appropriate resources. The care coordination process provides a full range of nursing and assists in meeting the comprehensive care needs of the patients and their families. Registered Nurse, eligible to be paneled by CCS to provide collaborative comprehensive care in a multidisciplinary setting

2 years in nursing in pediatric care or in an ambulatory setting
Graduation with a Bachelor Degree from an accredited University
Ability to work effectively under pressure due to changing priorities, interruptions, high/low census, payor demands and discharge planning demands; Excellent interpersonal communication, including conflict resolution, problem solving and negotiation skills; Clinical knowledge of multiple age groups, medical illness and treatment plans according to disease process, diagnosis and anticipated LOS; Strong organizational and time management skills, as evidenced by capacity to multi-task and prioritize; Ability to work independently and exercise sound judgment in interactions with physicians, payers, patients and their families; Demonstrates the knowledge and skills necessary to communicate with third party payers to obtain authorization for the appropriate treatment setting for patients requiring medical, psych and chemical dependency treatment; Must be proficient in required competencies upon completion of orientation and maintain annual departmental competency requirements; Ability to work collaboratively regardless of social, economic and cultural backgrounds; Computer knowledge to include skills in using Microsoft Office (Excel, Word, Power Point, Access)

3+ years of nursing experience in an emergency department and/or case management, care coordination or transition of care Previous pediatric experience and/or management, and/or charge nurse roll acceptable
Bachelor or Master Degree in Nursing or a health related field from an accredited University
Certification in Case Management
Knowledge of CCS/Medi-Cal regulations and requirements; Knowledge of third party payor requirements in order to optimize reimbursement; Ability to apply severity of illness/ intensity of service pediatric criteria to information extracted from clinical documentation; Bilingual

1. Nursing Assessment and Interventions: Provides comprehensive, culturally sensitive, and developmentally appropriate assessments and interventions with patients/families

Performance Expectations 1.1 Performs the essential functions of case management in a collaborative process which assesses, plans, implements, coordinates, monitors and evaluates options and services to meet the health care needs of the patients through communication and available resources to promote quality cost-effective outcomes 1.2 Assures timely, accurate documentation in accordance with hospital policy and CCS guidelines 1.3 Intervenes with patients and families regarding emotional, social, and financial consequences of illness and/or disability; accesses and mobilizes family/community resources to meet identified needs 1.4 Provides support in legally complex cases-guardianship, adoption, foster care, advanced directives, etc 1.5 Facilitate coordination, communication and collaboration on behalf of the patient/family and the payer to achieve patient specific goals and outcomes 1.6 Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system 1.7 Serves as a resource and provides intervention related to treatment decisions and end-of-life issues

2. Transitions of Care: Participates in transitioning and providing care coordination activities for patients, in order to ensure a timely discharge and to provide appropriate linkage with post-discharge care providers

Performance Expectations 2.1 Receives referrals for patient problem resolution from the patient or members of the healthcare team 2.2 Promotes clinical excellence by remaining current in evidence based practice and standards of care for improvement in patient and family outcomes 2.3 Works with families exhibiting complex family dynamics that impact directly on patient care, discharge and transitions 2.4 Addresses/resolves system problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge or transition that negatively impact LOS or readmissions 2.5 Works collaboratively and maintains active communication with care coordinaton, physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management 2.6 Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge or transition 2.7 Contribute to the current list of home health agencies, durable medical equipment resources, hospice, sub-acutes, counseling, housing, legal, long term care facilities and other needed resources, appropriate to contracted payer requirements

3. Collaboration

Performance Expectations 3.1 Collaborate and communicate in a positive manner with physicians/primary care providers, patient and family, and other members of the multi-disciplinary team to foster a safe therapeutic environment and establish optimal outcomes 3.2 Decisions regarding patient care are made in an ethical, culturally sensitive, and developmentally appropriate manner 3.3 Serves as a resource by planning, facilitating and providing community outreach and/or educational activities within area of expertise to patients, families and the community 3.4 Educates patient/family and physician regarding community resource options of choice

4. Customer Service

Performance Expectations 4.1 Support and promote excellence in customer satisfaction by partnering with the patient/family in the development of the plan of care 4.2 Communicate pertinent, complete, and unbiased information regarding treatment plan, in ways that are useful to promote the health and well being of patients and families 4.3 Provide patient/family education that reflects health maintenance, wellness, recovery, and injury prevention, which is family-centered, culturally sensitive, and developmentally appropriate 4.4 Address all customers in a pleasant and respectful manner 4.5 Interact with peers and colleagues with compassion, respect, professionalism, and encouragement 4.6 Promote teamwork to provide positive experiences for patient, family, peers, and colleagues 4.7 Utilizes sound judgement with time management

5. Complete goals and objectives as assigned for the performance evaluation period

Performance Expectations 4 5.1 Objective/Goal completed on time

Population Served:
Infant/Neonatal Birth to 1 year-Regularly
Toddler 1 year to 3 years- Regularly
Preschool 3 years to 6 years-Regularly
School 6 years to 12 years- Regularly
Adolescent 12 years to 18 years-Regularly
Young Adult 18 years to 25 years- Infrequently

Core Values:
iCare Principles
1.1 Communication and Information Sharing * Smile, make eye contact, greet others, provide my name and role when interacting with others * Communicate with sincerity, honesty and respect for culture diversity * Actively listen with respect and compassion, without interrupting * Encourage feedback and questions * Partner with families in order to understand and meet their unique needs * Collaborate to achieve optimal outcomes
1.2 Accountability * Commit to delivering excellent service every day * Remember the importance of the "first impression " * Adhere to departmental and CHOC policies * Conserve CHOC resources and supplies by using them wisely and in the best interest of CHOC * Take responsibility for my actions, welcome views of others, and maintain objectivity * Take pride in my environment by maintaining safe and clean surroundings * Maintain professional boundaries with patients, families, colleagues and vendors
1.3 Respect * Speak to patients and others in ways that are clear and non-judgmental * Show concern, interest and follow-through with commitments * Do not engage in negative behaviors such as second-guessing, undermining, infighting, arrogance, gossiping and back-stabbing * Ask patients and those I serve how I can best support them and never assume I know what is best * Speak in a positive manner about our Associates, medical staff and organization * Respect privacy and confidentiality at all times
1.4 Excellence * Take ownership to continuously improve processes within my role, department and throughout CHOC * Strive to improve myself and the outcome of my work * Seek opportunities for improvement, understand what's expected of me, and apply best practices * Embrace change and offer suggestions for resolutions to challenges * Take action if I see an unsafe act or condition that impacts quality of care or the safety of others * Recognize others for outstanding performance 1.5 Core Values *Evaluate the associate's overall integration of CHOC's iCARE Principles and Core Values in their daily interactions which consistently demonstrate Excellence, Innovation, Service, Collaboration, Compassion and Accountability