Manager, Ambulatory Care Management - Value Based Service Organization - Full Time 8 Hour Days (Exempt) (Non-Union) -

The Manager of Ambulatory Care Mgmt. provides operational support to the Ambulatory Care Management Department to ensure compliance with program requirements. The Manager of Ambulatory Care Manager is accountable to ensure: 1) daily staff assignments and workloads, 2) effectiveness and productivity of staff work , 3)overall program results and impact, and 4) To ensure that medical services (inpatient and outpatient) are directed and managed at the most effective and appropriate level of service according to the member's medical condition. This position will provide support for program, as assigned by the Director of Case Management or Medical Director. Serves as a manager resource for education and effective ambulatory care management strategies and applications. In collaboration with the interdisciplinary team, the Manager will also assist Care Managers in providing care coordination services evaluating options and services required to meet an individual's health care needs to promote cost-effective, quality outcomes. Serves as a consultant to members of the health care team in the management of specific patient populations. The RN ambulatory care manager role integrates the functions of complex case management, utilization management, quality management, discharge planning assessment, and coordination of post-hospital care services, including transfers to an alternative level of care. As more complex medical treatment options emerge the Nurse Ambulatory Care Manager will look to eliminate gaps in the care provided, as well as needlessly duplicated treatment, all while controlling the cost of quality patient care. The Nurse Ambulatory Care Manager will leverage their clinical and social work experience to ring an understanding of the clinical process of assessment, planning, implementation, and evaluation to the process of case management. Some of the major duties of an ambulatory care management nurse include: • Documenting patients' case management plans and on-going activities • Identifying patients 'insurance coverage or other sources of payment for services • Identifying and addressing patient risk factors and/or obstacles to care • Identifying patient needs, current services, and available resources, then connecting the patient to services and resources to meet established goals • Communicating the care preferences of patients, serving as their advocate, and verifying that interventions meet the patient's needs and treatment goals. • Screening patients and/or population for healthcare needs • Developing a patient-focused case management plan • Educating the patient/family/caregiver about the case management process and evaluating their understanding of the process Some of the major duties of an ambulatory care management nurse overlap into inpatient duties including: • Concurrent review of all patients to validate that the appropriate patient status is assigned upon admission and prior to discharge • InterQual or MCG reviews are completed within 24 hours of admission • Observation patients are effectively care managed on a daily basis • Facilitate throughput and timely discharges throughout inpatient level of care

Essential Duties:

• Responsible for overall program development and implementation: Serves as a lead manager resource for establishing overall program goals and developing effective ambulatory care management solutions. Develops of each ambulatory care management program’s business requirements. Defines and documents key processes needed to support these programs. Implements the ambulatory care management IT system to support this programs goals and objectives. Develops clinical content, including but not limited to: assessments, clinical guidelines, health educational materials, etc. Develops orientation and training for program staff. Develops and implements program process and outcomes measures, including overall evaluation and return on investment.
• Managing the program’s services, outcomes, and resources/staff: Manage and oversee program and staff performance includes recruiting, hiring, and training all staff positions for this program; daily staff assignments and workloads; effectiveness and productivity of staff work; and overall program results and impact Ensures that medical services (inpatient and outpatient) are directed and managed at the most effective and appropriate level of service according to the member’s medical condition Builds team, then manages to meet all current and future goals and objectives Provides orientation and training for ambulatory care management staff. Reviews and assigns work to staff members Collaborates with interdisciplinary teams (IDT) and leads forum and care manager/s in providing care coordination services by evaluating options and services required to meet an individual’s health care needs to promote cost-effective, quality outcomes. Provides consultation to ambulatory care managers on appropriate patient status and provides a second opinion, expertise and problem solving assistance. Manages team to ensure complete documentation for patients in this program, including and not limited to: 1) Network hospitals, 2) Out-of-Network hospitals, 3) SNFs, 4) Observation status, 5) Discharges, 6) CCM Census, 7) CCM New Assessments, and 8) CCM Interventions Manages and oversees quality improvement activities including but not limited to audits, interrater reliability studies, quality data collection, provider performance, and network selection and development Ensures that functions and activities are in compliance with appropriate program and regulatory standards, including, but not limited to health plans, NCQA, Joint Commission, Federal, State, and professional codes. Adheres to Health System policies and procedures
• Responsible for performing clinical, ambulatory care management with patients and physician contact: Performs and leads in care management to ensure new processes, programs, and systems work optimally Analyzes and reviews services/workflows to eliminate gaps in the care provided, as well as needlessly duplicated treatment, all while controlling the cost of quality patient care. Leverages clinical and social work experience to ring an understanding of the clinical process of assessment, planning, implementation, and evaluation to the process of care management. Maintains competency in application of current clinical guideline-based criteria, including but not limited to: CMS, InterQual, MCG, health plan, etc
• Performs all duties as assigned.

Required Qualifications:

• Specialized/technical training Nursing Graduate of an accredited school of registered nursing.

• 5 years Five years+ clinical experience with three years+ of experience in ambulatory case management.

• Ability to work independently with minimal supervision, exercising judgment and initiative.
• Ability to manage multiple tasks with effective prioritization.
• Process oriented.
• Good computer skills.

Preferred Qualifications:

• Bachelor's degree Nursing BSN
• 2 years Two (2) years+ experience in an HMO/IPA/Managed care setting is preferred and recommended.
• Knowledge of CM standards, UM standards, clinical standards of care, NCQA requirements, CMS guidelines, Milliman guidelines, InterQual guidelines, and Medicaid/Medicare contracts and benefit systems is preferred.
• Certified Utilization Review Professional CM and/or UM training and/or certification.

Required Licenses/Certifications:

• Registered Nurse - RN (CA Board of Registered Nursing) Valid California Registered Nurse license.
• Basic Life Support (BLS) Healthcare Provider from American Heart Association
• Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

The annual base salary range for this position is $110,240.00 - $181,896.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.