- Full Time/Contract
- Managed Care Nursing
- Rancho Cucamonga, CA
Our Client is a not-for-profit, rapidly growing Medi-Cal and Medicare health plan serving over 1,138,447 residents of the Riverside and San Bernardino counties. Our client maintains a Positive Team Culture as demonstrated by being voted by Los Angeles News Group readers as "Favorite Overall Company to Work For”, "Favorite Training Program”, and "Favorite Workplace Culture” in their 2014 Winning Workplaces survey.
Discharge Planner, LVN
Under the direction of the Inpatient Review Nurse Manager and Supervisor, the incumbent will work with their respective Team Centers, that may include an Concurrent Review Nurse and Inpatient Coordinator, along with hospitals and IPAs, to initiate coordinated and continuous cost effective discharge planning to ensure the continuity Member's care needs are met timely and readmission prevention is anticipated for Members
- Responsible for assisting with data collection for utilization review, including, but not limited to Member specific needs for daily review in anticipation of discharge needs within 24 hours of admission.
- Responsible for the arrangement of transitions to lower or higher level of care and assists with transfer orders as needed.
- Responsible for authorizations for outpatient services or ancillary services in preparation for the Member's discharge, including, but not limited to home care, home therapies and durable medical equipment.
- Responsible for ensuring that discharge needs for Member's include referring Members to Health Management, Health Education, Care Management, Behavioral Health or other internal or external programs as needed.
- Anticipates and acts upon barriers to ensure effective Member progression by identifying clinical, operational, financial, and social issues that may affect patient outcomes and provides recommendation to the Concurrent Review Nurse for collaboration in an effort to assist Members with adhering to treatment plans and goals.
- Responsible for assisting Team Center with the identification of Members who are at risk for extended lengths of stay, readmission, high utilization and/or complex discharge needs within the LVN scope of practice.
- Responsible for timely compliance and completion of cases as required by regulatory requirements.
- Responsible for working with other Team Members, departments, IPAs and the facilities to support the goals of the department as well as strategic priorities and vision of the organization.
- Any other duties as required to ensure Health Plan operations are successful.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in 's policies and procedures relating to HIPAA compliance.
QUALIFICATIONS / REQUIREMENTS
Possession of a valid LVN license issued by the State of California. Possession of a valid State of California driver's license automobile insurance.
Two or more years of utilization management/case management in a health care delivery setting with an emphasis on discharge planning and utilization management.
Self-starter and a team player. Responsible for the performance of concurrent and retrospective reviews for medical necessity and appropriateness of service and care. Knowledge of evidence based clinically criteria and California Children Services (CCS). Must have analytical skills, time management, and problem solving abilities. Must have a high degree of patience, excellent communication, interpersonal and organizational skills.