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Out of Area Inpatient Care Manager

Out of Area Inpatient Care Manager

Job Title: Out of Area Inpatient Care Manager​
Job Category: Nursing (RN)
Division: Torrance Health IPA
Position Type: Full time
Shift Length: TBD
Location: Torrance, CA

Resumes go to: Barbara.Latam@tmmc.com

The Out of Area (OOA) Inpatient Care Manager (ICM) provides clinically-based case management to support the delivery of effective and efficient member care in the acute hospital setting when members are admitted to acute level of care facilities other than Torrance Memorial Medical Center (TMMC).

The role integrates utilization management, care coordination, and transition planning functions. ICM has the overall accountability for a designated case load and plans effectively in order to meet member’s needs, manage the length of stay, and promote efficient utilization of resources. Supports and manages members transitioning to and from TMMC based on acuity and medical necessity in support of the hospitalist team directives.

As a member of the interdisciplinary team, the ICM supports the Hospitalist in facilitating appropriate OOA, non-TMMC admitted inpatient member care with the objective of ensuring care is appropriate at the external facility and discharge planning will be supported, or repatriation of members when care is not progressing, member needs are questionable or complex, requiring more hands on management by the TMMC hospitalist team.

Primary Duties and Responsibilities:

  • Contacts external acute care facilities upon notification of admission of a THIPA member to a non-TMMC acute level of care facility
  • Establishes if admission is THIPA or Plan financial responsibility based on Division of Financial Responsibility (DoFR)
    • If Plan responsibility, notifies hospital to contact plan and establishes an authorization in the THIPA authorization system for ‘tracking purposes only’
  • Facilitates transfers to TMMC when notified of Emergency Department member contact with stable condition at alternative facility when member requires admission
  • Establishes communication for ongoing support when notified of member admission to a non-TMMC acute level of care facility
  • Apply approved clinical criteria to monitor appropriateness of admissions and continued stays to ensure a clear status determination, assessing appropriateness of level of acuity and care
  • Discusses cases with the hospitalist reviewer for ongoing decision making as it relates to continued stay, discharge planning and/or repatriation
  • Arranges and/or facilitates repatriation, identified discharge plan and services of members and ensure timely intervention to prevent delays in service and transition of care
  • Presents cases and participates in discussion at Interdepartmental Meetings (IDT)
  • Participates in case discussions with the hospitalists regarding continued stay and discharge planning needs of each member
  • Participates in department specific initiatives and department meetings
  • Identifies members and families with complex psychosocial issues and refers them to the Social Worker as appropriate. Demonstrates skill and success in collaboration with Social Work partner.
  • Documents results of assessments, status assignment, and activities or interventions and discharge planning in the electronic medical record and/or alternative electronic documentation system according to departmental policies and procedures
  • Facilitates transfer to other facilities as directed by the appropriate physician leadership
  • Initiates referrals for home health care, hospice, and medical equipment and supplies
  • Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial member assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation
  • Following department procedures, prepares comprehensive care plan that includes action steps and resources
  • Documents care plan and subsequent changes electronically
  • Routinely coordinates with member and/or family regarding action plans and resources to carry out care plan recommendations
  • Communicates with Ambulatory Care Managers to ensure smooth transitions
  • Remains current with relevant healthcare requirements and the relevant professional literature

Skills, Knowledge, & Abilities:

  • Thorough knowledge of case management
  • Understanding of family and group dynamics
  • Familiarity with behavior modification techniques
  • Knowledge of resources in the community, laws, regulations, and policies that govern case management
  • Skill in establishing and maintaining rapport with members, families, and local resources (medical, social, civic, legal and religious organizations)
  • Ability to establish and maintain professional relationships and communication with a wide variety of people and to work as a team member
  • Ability to form helping relationships with patients and family members of all ages and cultural backgrounds, regardless of diagnosis or disability
  • Ability to handle multiple tasks simultaneously and set appropriate priorities
  • Working knowledge of Federal, State and local community resources, services and programs
  • Ability to maintain confidentiality of all patient information

Education and/or Experience:

  • Bachelors/Associate degree in nursing with current California RN license or LVN license
  • Two years acute or subacute hospital experience or two years in home health, utilization management or case management background required
  • Care Management Certification: CMC, CCM desirable
  • Current BCLS certification

Qualified candidates should submit their resume to Barbara.Latam@tmmc.com for consideration.