Provider Network Specialist jobs in Costa Mesa, 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 care plan 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 right 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 the safe discharge of patients with the necessary resources to insure that care is provided without interruption along the continuum of care, that is, whether in a skilled nursing facility, assisted living facility or in the home setting. Such discharge will be planned and coordinated in collaboration with the Vital Care Case Manager for patients enrolled in the Vital Care program. The Inpatient Case Manager will document the discharge plan, together with the current medication list, and scheduled follow-up appointments in the authorization notes and will communicate the same to the Vital Care Case Manager, the patient, and family members concerned. A follow-up post-discharge call will be made by the Inpatient Case Manager or the department's designee within 24 hours of discharge to determine any problems, issues, or risks encountered in the transition.

Essential Duties and Responsibilities include the following:

• Anticipates our customer needs: Understands the wants and needs of customers, listens for cues and identifies how to respond and at the appropriate level of intervention needed.
• Surveys the customer's environment and takes appropriate action.
• Refrains from discussing personal business in front of the customer or speaking a foreign language different from the customer's language.
• Greets patients, family members, visitors, and physicians in a positive manner by introducing self, speaking clearly and with confidence.
• Returns phone calls to customers and follows up with requests.
• Keeps patient/family member or other customer informed and requests if further assistance is needed.
• Assists others and supports the team.
• Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
• Demonstrates honesty and integrity in everyday activities.
• Recognizes when an error is made and reports them appropriately.
• Protects privacy for both patients and employees; ensures information sensitive papers, charts, and reports are not in view of the public.
• Recognizes when an error has been made and immediately reports to appropriate manager.
• Participates in “service recovery” through follow-up with the injured party, gathering information, and demonstrates empathy.
• Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families. Functions as liaison between administration, patients, physicians, and other healthcare providers.
• Interacts professionally with patient/family/physicians and involves patient/family/physicians in the formation of the plan of care.
• Communicates appropriately and clearly to management, co-workers, and physicians.
• Identifies and addresses psychosocial needs of the patients and family and facilitates consultations with a Social Worker, as necessary.
• Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate.
• Communicates using age appropriate language.
• Understands and applies principles of adult learning methods as they relate to health care educational needs.
• Receives and reviews physician's orders; documents completion. Follows through to ensure orders are carried out.
• Consults other departments as appropriate to provide for an interdisciplinary approach to the patient's needs.
• Formulates an outcome-based plan or care, based on assessed patient needs, implements and evaluates plan as evidenced by documentation.
• Maintains quality monitors as assigned by Supervisor.
• Performs other duties as assigned
• Participates in orientation, instruction/training of new personnel.
• Pursues additional education (in-services, seminars, self study, formal education programs) to advance nursing skills and knowledge.
• Documents patient assessment and reassessment, patient care plans, and other pertinent information completely, in the patient's medical record according to nursing standards and policies.
• Assures complete and proper charging of supplies.
• Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.
• Completes daily documentation, required letters, and referrals in a timely manner.
• Other duties as assigned.

The pay range for this position at commencement of employment is expected to be between LVN's $37.50 - $40 per hour or for RN's $45 - $50 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

Education and / or Experience:

• Graduate from an accredited Registered Nursing Program or Licensed Vocational Nursing Program.
• Current California Licenses
• Knowledge of Healthcare and Managed Care preferred.
• Typing 40 words per minutes with accuracy.
• Knowledge of computers, faxes, printers and all other equipment.
• Knowledgeable in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point).
• Ability to deal with responsibility with confidential matters.