Company: Hill Physicians Medical Group
Location: La Verne
Posted on: November 20, 2023
We're delighted you're considering joining us!
At Hill Physicians Medical Group, we're shaping the healthcare of
the future: actively managed care that prevents disease, supports
those with chronic conditions and anticipates the needs of our
Join Our Team!
Hill Physicians has much to offer prospective employees. We're
regularly recognized as one of the "Best Places to Work in the Bay
Area" and have been recognized as one of the "Healthiest Places to
Work in the Bay Area." When you join our team, you're making a
great choice for your professional career and your personal
At PriMed, your uniqueness is valued, celebrated, encouraged,
supported, and embraced. Whatever your relationship with Hill
Physicians, we welcome ALL that you are.
We value and respect your race, ethnicity, gender identity, sexual
orientation, age, religion, disabilities, experiences,
perspectives, and other attributes. Our celebration of diversity
and foundation of inclusion allows us to leverage our differences
and capitalize on our similarities to better serve our communities.
We do it because it's right!
Responsible for carrying out case management activities for IPA
members referred to the case management program across all levels
of care. Case management is a collaborative process that assesses,
plans, implements, coordinates, monitors, and evaluates options and
services required to meet the client's health and human service
needs. It is characterized by advocacy, communication and resource
management and promotes quality and cost-effective interventions
and outcomes. Case management activities are based on nationally
recognized case management standards and concepts and principles.
All contacts are telephonic with an option for on-site case
conferences as needed.
- Identification of members appropriate for case management,
based on identification of health-related problems.
- Assessing members' physical and psychosocial
- Developing the case management care plan.
- Developing and implementing the interventions needed to resolve
barriers and coordinate care, allowing members to accomplish their
goals with physician guidance and supervision.
- Documenting assessments, care plans, interventions, and all
other activity related to coordinating the care of case-managed
- Maintain client privacy, safety, confidentiality, and advocacy
while adhering to ethical, legal, regulatory and accreditation
- Maintain department procedure/policy standards with regard to
turnaround time, etc.
- Support the interdisciplinary team approach to ensure effective
resource utilization, as well as quality and cost-effective
- Coordinate internal and external resources for the individual
- Maintain and update a community resource database.
- Document all case management activities in the HPMG case
management online system.
- Utilize existing reports and systems to identify and monitor
utilization resource patterns and facilitate needed care
coordination in order to support Quality Improvement.
- Refer to various departments for supportive interventions,
i.e., Health Education, Quality Management, Contracting, Provider
Services, Client Data Management, TPL, COB, etc.
- Issue letters of explanation in accordance with department
- Support Medical Management Team, Authorization Review, Clinical
Initiatives, and Provider Education.
- Attend and participate in in service programs and conferences
that support practice of case management.
- Perform other duties as assigned.
- Minimum 3 - 5 years of experience required
- Minimum three years clinical nursing experience in an area such
as medical surgical, critical care, home health or skilled nursing,
- Two years of experience in case management, utilization
management, discharge planning and or quality improvement in a
managed care setting
- Experience with managed care delivery including IPA networks
- Optimum organizational skills with ability to meet both
expected and unexpected time frames.
- Excellent verbal and written communication skills.
- Ability to coordinate effectively with a variety of customers
including members, providers, office staff, health plans, internal
department, community resources, and peers.
- Ability to work independently with self-initiative and
- Knowledge of ICD-10 and or CPT coding.
- Working knowledge of personal computers.
- A.S. degree
- Unrestricted California Registered Nurse licensure;
certification in case management preferred.
$82,800.00 - $115,100.00
Hill Physicians is an Equal Opportunity Employer
Keywords: Hill Physicians Medical Group, Los Angeles , Case Manager, Executive , La Verne, California
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