Ambulatory Care Manager Details

Ambulatory Care Manager

CEDARS-SINAI - Beverly Hills, CA

Employment Type : Full-Time

Are you ready to bring your clinical competencies to a world-class Medical Group known for the very highest clinical standards? Do you have a passion for the highest quality and patient satisfaction? Then please respond to this dynamic opportunity available with one of the best places to work in Southern California! We would be happy to hear from you.

The Cedars-Sinai Medical Network is committed to helping primary care and specialist physicians deliver care to all their patients, who benefit from convenient access to Physicians and coordination of care between them. As a part of Cedars-Sinai, our physicians and staff are partners in quality health care from a medical center that is consistently recognized as one of the finest hospitals in the country. For the 8th consecutive year, we have been named one of the top 20 Physician Groups in Southern California by Integrated Healthcare Associates (IHA).

The Care Manager has a demonstrated proficiency in the ambulatory care manager duties described below:

• Care manager makes an outreach call within 24 hours/1 business day of urgent referrals, 72 hours for routine referrals 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, depression screening, SDOH, available benefits, member/caregiver goals, degree of involvement, and resources, barriers to treatment. Accurately document above assessment in CS-Link.
• Consults with assigned Primary Care Physicians, as needed, to discuss status of new referrals and to discuss the status/treatment plan of patients enrolled in ACM.
• Ensure managed care referrals are processed, per NCQA Guidelines, and appropriately documented in CS Link Tapestry.
• Process all appropriate services based upon covered benefits, health plan or Milliman Care Guidelines, or medical necessity:
• Monitoring of continued appropriateness of the services rendered i.e., home health, DME, outpatient therapy.
• Work collaboratively with social workers re: alternate housing or placement and notification of transfer SNF of ALF. Transitions of Care are accurately and consistently documented.
• Transitions of Care Hand-Off, to assigned ISP CM, when ACM patients are admitted to CSMC.
• Ambulatory case managers will contact the patients telephonically, within 48 hours, post-discharge.
• Ambulatory Care Manager will meet patient, at physician appointments, as necessary, to build rapport with high-risk individuals, or, when additional support is required.
• Refer high risk patients to Supportive Care Services Program, and CS 360 Programs, as appropriate.
• Coordinate referrals and secure appointment with various CSMNS Disease Management programs such as Anticoagulation Clinic, Asthma, Diabetes, Hepatitis C, Smoking Cessation, Cardiovascular Risk, as appropriate.

• Graduation from an accredited school of nursing
• Valid California RN or LVN licensure

• 2-3 years of acute nursing experience; knowledge of medical/nursing standards of care
• Ability to effectively communicate and collaborate with physicians, patients/families, and ancillary staff to make sound, independent judgments and to act professionally under pressure
• 1-2 years of previous experience in case management in the acute inpatient or outpatient settings; knowledge of HMO and Medicare rules in inpatient, home health and at the SNF settings.
• Preferred candidates are Certified Case manager (CCM) certification for RN’s, utilization review (UR) experience, minimum of BSN (Bachelor of Science degree in Nursing) and 1-2 years Orthopedic surgery experience, Cardiac Care, Neurology, Spine or Gastroenterology.

Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.

At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through March each year) as a condition of employment, and annually thereafter as a condition of continued employment.