Case Manager, RN or LVN - La Palma, CA - Full-time / Part-time

AppleCare Medical Management Group was incorporated in 2003.  Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.
 
As a part of our continued growth, we are searching for an Inpatient Case Manager to join our team…
 
The Inpatient Case Manager will facilitate the inpatient utilization management process including in-network, out of network, case management and discharge planning as well as assisting the Associate Director of Inpatient Management with UM / QM functions as necessary.  Acts as a facility liaison to promote cooperation and efficiency between the IPA and the facility.
 
Primary Responsibilities:


Directly performs concurrent review
Coordinates, facilitates and documents comprehensive discharge planning
Ensures the appropriate utilization of capitated and contracted specialists, providers, facilities, and vendors according to region and risk
Attends inpatient review rounds and presents cases to medical director(s), health plans and ACMM management staff
Develops and maintains relationships with both network and Out of Network hospital UM and ER staff
Works directly with AppleCare Hospitalists to develop and implements inpatient processes

Required Qualifications:


Active unrestricted California LVN or RN license
2+ years of clinical experience as an RN or LVN
Case Management experience
Computer proficiency; can type, create, edit, search web browsers, toggle between multiple screens, use Word, Outlook, Internet and navigate in a Windows environment
Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area
Preferred Qualifications:


Experience in an IPA or MSO
Knowledge of HMO and ACO structures and operations
Knowledge of standardized CMS, Medicare Advantage, HMO, and Medi-Cal benefits structures
Understanding of DRGs
AppleCare Medical Management Group was incorporated in 2003. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.