Assistant professor of internal medicine

**THIS POSITION ID HYBRID in Orange, CA**

Job Summary

Medical Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for PACE members. The Medical Case Manager (PACE) facilitates communication and coordination among all participants of the health care team as well as to the member and/or caregiver to ensure the services are provided to promote quality cost-effective This position will provide intensive case management in a process that includes but not limited to, planning, implementation, coordination, monitoring, tracking and evaluation of the members ;

Position Responsibilities

• Performs comprehensive, disease specific, clinical assessment of all identified cases which includes but is not limited to assessment of:
  
  • Member s physical, functional, social and psychological status;
    
  • Member s cultural and linguistic needs;
    
  • Caregiver resources and available
    
• Develops and implements member specific care plans which include concrete prioritized, time-bound
  
• Provides consistent and ongoing follow-ups to assess progress towards goals and identifies barriers to meeting
  
• Communicates with members physicians, specialists, Skilled Nursing Facilities (SNFs), Assisted Living Facilities (ALFs), community agencies and other vendors to ensure coordination of
  
• Collaborates with hospital discharge planners for a smooth transition in care for members who are
  
• Prepares and maintains appropriate documentation of patient care and progress within the care plan following documenting
  
• Facilitates Interdisciplinary Team (IDT) meetings and develops a plan, identifies options and goals when indicated through multi-disciplinary
  
• Works collaboratively with interdepartmental staff in case
  
  • Identifies cases needing Manager, Director or Medical Director review or input, and route
    
• Advocates in the clients best interests for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and
  
• Evaluates for medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits
  
• Collaborates with PACE IDT and physicians in identifying high-risk patients, using criteria such as; patient s functional status, diagnoses, commorbidities, emergencies (ER), hospital utilization and social Monitors high-risk patients and provides appropriate interventions to mitigate
  
• Assists with prior authorization, concurrent review, and retro authorization of service as
  

Possess the Ability To:

• Maintain and ensure confidentiality of patient
  
• Communicate clearly and concisely both verbally and written
  
• Utilize computers, keyboarding, and appropriate software ( Microsoft Office applications and job-specific applications such as EHR) to produce correspondence, charts, spreadsheets, and/or other information applicable to the position
  

Requirements

Experience & Education

• Associate s degree required; Bachelor s degree in Nursing or related field is
  
• Current RN license to practice in the State of California is
  
• Minimum 2 years clinical experience working with the frail or elderly population Relevant experience must be within the last
  
• 3 years of case management and utilization experience
  
• Experience with Milliman Care Guidelines (MCG)
  

• Bilingual in English and in Spanish, Vietnamese, Korean, Farsi, Arabic, or Chinese is
  

Knowledge of:

• Guidelines and regulations relevant to PACE, case management, utilization management and principles and practices of health care, health care systems, and medical
  
• Legal and ethical issues pertaining to confidentiality in case
  
• National Committee for Quality Assurance (NCQA) QI 7 Standards; Complex Case Management
  
• Available community
  
• Charting practices and
  
• Available medical treatments and
  

Benefits

At Sunshine Enterprise USA LLC, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:

Competitive pay & weekly paychecks

Health, dental, vision, and life insurance

401(k) savings plan

Awards and recognition programs

Benefit eligibility is dependent on employment

Sunshine Enterprise USA is an Equal Opportunity Employer Minorities, Females, Veterans and Disabled Persons

Minimum 2 years clinical experience working with the frail or elderly population Relevant experience must be within the last 3 years of case management and utilization experience Experience with Milliman Care Guidelines (MCG) Bilingual in English and in Spanish, Vietnamese, Korean, Farsi, Arabic, or Chinese is Knowledge of: Guidelines and regulations relevant to PACE, case management, utilization management and principles and practices of health care, health care systems, and medical Legal and ethical issues pertaining to confidentiality in case National Committee for Quality Assurance (NCQA) QI 7 Standards; Complex Case Management Available community Charting practices and Available medical treatments and

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