8 days old

Nurse Care Manager ACO LPN or RN

HCA Healthcare
Foster City, CA 94404

Description

SHIFT: No Weekends

SCHEDULE: Full-time

 

Do you have the career opportunities you want in your current role? We have an exciting opportunity for you to join the nation's largest provider of healthcare services as a Nurse Care Manager.


HCA Healthcare is a national leader in providing modern, culturally competent, patient-centered care and we are driven by a single goal: the care and improvement of human life.


We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program and student loan repayment. We would love to talk to you about this fantastic opportunity.


The HCA Physician Services Group (PSG) is the physician and practice management solution for the Hospital Corporation of America (HCA). We lead a collection of highly motivated healthcare professionals just like you and creative leaders who are committed to excellence in every patient interaction. Are you excited yet?


   

Pacific Partners Management Services (PPMSI) is a managed services organization formed in 1997 with administrative offices located in Foster City, CA.  We provide services to IPAs in the Santa Clara and Monterey Bay areas.  Our managed care and ACO services support approximately 1,000 independent physicians and include executive management, full financial services, utilization management, quality improvement, credentialing, contracting, claims processing and provider and member network services.

   

PPMSI is part of HCA Physician Services Group (PSG), the physician and practice management solution for the Hospital Corporation of America (HCA). PSG operates more than 750 practices, Urgent Care Facilities, and partners with HCA’s 165 hospitals to structure employed provider programs, professional service agreements, and joint ventures that offer the communities we serve high quality, cost effective care. We manage a collection of highly motivated and innovative leaders who are committed to excellence in every aspect of their career.


Click here to learn more 

 

 

The ACO Care Manager’s primary function is to implement accountable care programs which meet contractually identified targets for efficiency and quality. The programs will be designed to implement interventions which will subsequently prevent unnecessary admissions, readmissions, and overutilization in a healthcare system, to meet the Triple Aim of better care, better health, and lower costs.

 

 

 

The ACO Care Manager initiates and coordinates a multi-disciplinary team approach to care management across the care continuum to ensure timely and appropriate access to care.  The ACO Care Manager effectively manages patients at high risk for healthcare complications to help improve their quality of life

   

CARE MANAGEMENT

 

  1. Initiate and coordinate a multidisciplinary team approach to care management which includes   patients, payors, and providers, across the care continuum.

     

  2. Evaluate patients’ comprehensive medical and social support and devise a comprehensive plan of care to support patients’ self-management of condition(s), arrange for services and ensure continuity of care at optimal levels.

     

  3. Design care plans which ensure seamless continuity of care, minimize the potential for duplication of services, and reduce fragmentation and gaps in care.

     

  4. Enhance and continuously improve communication and collaborative relationships with multi-disciplinary healthcare team members including payors and providers.

     

  5. Act as patient advocate protecting privacy and confidentiality issues.

     

  6. Provide patient education, monitor health needs, and coordinate community resources.

     

  7. Prevent adverse patient events to minimize poor outcomes.

     

  8. Maintain a comprehensive working knowledge of community resources, payor requirements, and network services available to the target population.

     

  9. Identifying opportunities for health promotion and illness preventions.

  10. Perform face-to-face patient visits in the home or physician office setting. All patient visits are “hands-off” visits for educational purposes only.

 

 

 

CLINICAL PROGRAM PARTICIPATION

 


  1.  Work with team members, both internally and externally, to provide accountable program results.

  2. Participate in accountable care management meetings, both internally and externally, as required.

     

  3. Attend accountable care training sessions, as required.

     

  4. Work with the PPMSI medical management team to develop tools and methods of identifying high risk patients using payor information as well as in-house analysis.

     

  5. Ensure targeted high risk chronically ill patients are enrolled in care management programs according to program requirements.

     

  6. Coordinate efforts with the Quality Management team to meet quality gate targets for identified patients, as required by the accountable care programs.

  7. Assume responsibility for special projects as assigned by the Medical Director.

 

 

SKILLS


1.     Advocacy, communication, education and counseling, and resource research skills.

 

2.     Core philosophy or values consistent with a family-center approach to care.

 

3.     Culturally effective capabilities demonstrating a sensitivity and responsiveness to varying cultural characteristics and beliefs.

 


 

 

 

Qualifications

REQUIRED

 

1.    Current unrestricted California RN Licensure.

2.    Minimum of 3-5 years of previous experience in a managed care organization or other comparable experience  

3.    Experience and competence with Microsoft Office( Excel, Word, Powerpoint) and internet-based software tools.

4.    Excellent written, verbal, telephonic skills.

5.    Excellent data gathering, data analysis and summary-level reporting skills.

6.    Ability to prioritize tasks and thrive in a highly productive environment.

7.    Ability to communicate effectively, both verbally and in writing, with executive clinical and non-clinical leadership, payor representatives and providers and their office staff.

8.    Strong professional level of knowledge and comprehensive clinical assessment skills in the areas of population and chronic disease management.

9.    Familiar with current clinical practices for adult and pediatric medical, surgical and psychiatric care.

10.  Familiar with standard review criteria such as Interqual and/or Milliman.

 

 

REQUIRED LICENSES/CERTIFICATIONS

 

1. RN- Registered Nurse or LVN- Licensed Vocational Nurse

2. Active, unrestricted California License

 

 

HCA Healthcare ranks on Fortune’s list of Most Admired Companies for three consecutive years and HCA ranks 63rd on the Fortune 500 list. In addition, Ethisphere named HCA as one of the World’s Most Ethical Companies. We want you to join our tradition of excellence. Intrigued? We’d love to hear from you.


If you find this opportunity compelling, we encourage you to apply. We promptly review all applications. If you are highly qualified, you will hear from one of our Practice Managers. We are actively interviewing so apply today.


We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Notice

Our Company’s recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking here.

For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.

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Posted: 2019-12-03 Expires: 2020-01-02

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Nurse Care Manager ACO LPN or RN

HCA Healthcare
Foster City, CA 94404

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