Register Nurse CalAIM
Step UpRegistered Nurse/Case Manager Enhanced Care Management
REPORTS TO: Senior Program Manager
HOURS: 40
CLASSIFICATION: Exempt
REQUISITION NUMBER: 1816
SUMMARY:
Under the direction of the Senior Program Manager the Registered Nurse (RN) works collaboratively within an integrated service delivery model to assess, maintain, and strengthen program delivery and services using a whole-person, team-based approach for individuals and families enrolled in ECM programs. The RN provides quality assurance, clinical compliance, administrative support, case management, and care coordination for members enrolled in Enhanced Care Management (ECM). This role offers healthcare expertise and advocacy, supports case managers serving San Bernardino and Riverside County, engages in community outreach and direct member support, and requires initiative, integrity, dedication, and a strong commitment to improving outcomes for people with diverse social determinants of health.
Work Schedule: Hybrid (in-person office and direct staff/member field support)
ESSENTIAL DUTIES - The following reflects essential functions for this job but does not restrict other tasks which may be assigned:
Leadership, Administration, Oversight
- Complete and become proficient in each Healthcare Plan’s Electronic Health Record to ensure documentation is accurate and in compliance with DHCS regulatory requirements and accreditation standards for all Step-Up ECM and CS contracts.
- Ensure the privacy and security of the PHI as outlined in Step Up’s policies and procedures relating to HIPAA complaints including attending annual compliance training.
Direct Service and Support
- RN may also participate and not limited to:
- Crisis response o Suicide ideation and self-harm o Grief and abandonment o Family breakdown o Referral services
- Advocacy of Services
- Within the full scope of the Nurse Practice Act, may assess, plan, organize, provide, and/or oversee nursing care to patients in accordance with physician instructions; may make preliminary observations of, and prepare patients for, medical treatment.
- Provide field-based services within a patient's home or in the community at least once a week and support staff in a field-based setting, as needed.
- Assist Members in navigating the healthcare system, helping Members successfully participate in their medical and/or behavioral health care by overcoming barriers to care, sharing information on barriers with the PCP to improve care and outcomes.
- Assisting with members’ transition upon discharge from medical or psychiatric hospitals. By coordinating with hospital discharge planning, being supportive in plan transitions and collaboration with all institutions, clinics and relative conglomerates.
- Collaborate on Member care issues with other Step Up’s ECM team in scheduled systematic case reviews and ad hoc case reviews and consult with Director of Nursing and clinical therapists before taking any action that is clinical in nature.
- May review the post hospital care plan with the patient/family, establishing a contact regarding time frames.
- Interface with professionals from within and outside of assigned areas (pharmacy, hospitals, durable medical equipment, etc.) to provide assistance and professional recommendations as needed.
- Build and maintain a positive working relationship with members and providers including by not limited to communication via in-person, over the phone, and through digital means, such as email and fax.
- Participate in various committee meetings and present and/or gather data and information to assist with tracking interdisciplinary collaborative team meetings.
- Participate in committee activities related to performance improvement issues by auditing members’ records and presenting performance improvement plans to the department staff regularly.
- May coordinate and monitor patients through the hospitalization process utilizing physicians, primary care nurses, and third-party payers.
- May be responsible for oversight, development, implementation, and coordination of special programs, services, and education in the healthcare setting.
- Assist with the coordination of medical and behavioral health access issues with Step Up programs (not limited to ECM, CS, FSP, PSH, etc.), PCP offices, and specialists.
- Serve as a resource person to other staff members; conduct research, contract monitoring and special unit studies to maintain interdisciplinary collaborative team meetings (ICT and/or IDT Meetings).
- Assess training needs of the assigned unit or program, and draft recommendation standards of care, policies, procedures, and quality indicators as assigned; provide education for the staff and monitor.
- Participate in the development of standards of care activities; serve as a preceptor and ongoing mentor to nursing staff; assign and monitor. Review and/or revise policy and procedures as needed.
- Model commitment to continuous quality improvement by engaging in quality improvement initiative and projects such as by identifying and assessing gaps and by identifying, developing and testing new practices for improving the outcomes of the ECM and CS departments.
- A mandated reporter and advocates for the health, protection and safety of the enrolled member.
- Any other duties as required to ensure CS and ECM operations are successful.
Documentation and Data Collection
- Review and maintain clinical assessments and specialized mental health assessments.
- Medication review, reconciliation and interaction, and physical health monitoring (blood pressure readings, lab work, nutrition, etc.) regularly.
- Maintain documentation for each member contact as instructed and within the program timelines (within 48 hours, weekly, monthly, and quarterly).
- Review and provide advisory for members’ care plans and chart reviews: Due 90 days after member enrollment, discharge, key event and/or health changes.
- Submitting billable notes to provider portals, Step Up electronic health records (Welligent) and maintaining member’s charts and profiles, systems, and portals within Step Up’s contracts.
- Report emergencies, urgent care needs, crisis, etc. to Step Up management necessary documentation.
MINIMUM QUALIFICATIONS: Education: Graduation from an accredited college or university with a bachelor's degree in nursing or health-related field and Current active California Registered Nurse (RN) license in good standing required. Experience: At least one to three years as a full-time Registered Nurse. A master's degree from an accredited college or university in nursing or a health-related field may be substituted for two years of the required experience; preferred not required. One year ECM experience preferred. Valid California driver's license, reliable transportation, and current automobile insurance required.
Knowledge of: Current principles, techniques and procedures used in professional nursing; medical terminology and patient care routine appropriate to clinical setting; medical instruments and equipment; the uses and effects of medicines and narcotics; community resources available to provide patient care and follow-up; federal, state and local laws and regulations governing professional aspects of nursing; identification of potential discharge needs; payor source documentation requirements and governmental regulations affecting reimbursement.
Additional Working Knowledge Requirements for Mental Health Applicants: Current child, dependent adult, and elder abuse reporting laws; current involuntary detention and commitment laws related to mental health; involuntary psychotropic medication laws; and Tarasoff-duty to warn requirements.
Ability to: Perform the full range of nursing duties and responsibilities in a patient care setting; plan, organize and implement nursing plans for patients; prepare and maintain concise and complete records and reports; establish and maintain effective working relationships with physicians, patients and co-workers; secure the cooperation of employees to work effectively together; keep abreast of developments in areas of nursing specialization; teaches, mentors and supervises others routinely; effectively prepare and present reports and recommendations both orally and in written form; evaluate the medical records of hospital admissions; provide recommendations regarding continued stay necessity; identify discharge needs; collect and evaluate data, draw conclusions and formulate recommendations.
In Mental Health, ability to use individual professionally sound judgment to make complex decisions related to: triage; clinical assessments including biopsychosocial evaluation; integration of mental health, chemical dependency, and physical healthcare needs; potential suicidality; placement issues and necessary linkages and supports; and need for emergent psychiatric care and consultation.
SUPPLEMENTAL INFORMATION: Work with people experiencing homelessness whether on the streets, in shelters or other places of habitation or services, may present inherent challenges and difficulties such as: exposure to bed bugs or other infestations, unpleasant smells or odors, individuals who may have poor hygiene or unclean homes due to homelessness, mental health symptoms, or poverty. Additionally, in working with our members, employees may encounter instances of profanity, sexually explicit or derogatory language, or verbal or physical expressions of anger and trauma. Very rarely do these situations ever escalate to physical contact, and negative or derogatory communication patterns can often be negotiated successfully. All direct care staff are provided adequate training to develop skills to deescalate crisis situations that may arise and Step Up has established procedural safeguards for all employees to mitigate (but not eliminate) these inherent risks of employment.
PHYSICAL REQUIREMENTS: While performing the duties of this job, the employee is regularly required to sit; use hands and fingers; handle or feel; reach with hands and arms; talk; and hear. The employee is frequently required to walk, balance, stoop, kneel, and/or crouch. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus. Keyboard data entry required.
Step Up utilizes the principles of trauma-informed care and mental health recovery. These principles inform our Core Values of Hope, Wellness, Voice and Choice, Respect, and
Collaborative Relationships. As representatives of Step Up, employees agree to adhere to these values in their interactions with members, colleagues, supervisors, and associated community members.
STEP UP CORE VALUES
HOPE – We believe all people have the capacity for positive growth and change. We use hope to inspire and motivate ourselves, our members, our colleagues, and our community.
WELLNESS – We believe in promoting a culture that supports healthy and fulfilling lives. We use a supportive environment to foster well-being for ourselves, our members, our colleagues, and our community.
VOICE AND CHOICE – We believe in the right to choose and be heard. We use voice and choice to create meaningful outcomes and empowerment for ourselves, our members, our colleagues, and our community.
RESPECT – We believe in promoting interactions that are non-judgmental, transparent. We use respect to guide all of our words and actions with ourselves, our members, our colleagues, and our community.
COLLABORATIVE RELATIONSHIPS – We believe in forming partnerships to share resources, knowledge, and experiences. We use collaborative relationships to strengthen accomplishments for ourselves, our members, our colleagues, and our community.
Step Up provides equal employment opportunities without regard to age, ancestry, color, creed, mental or physical disability, marital status, medical condition, national origin, race, religion, sex, sexual orientation, veteran status, or any other consideration made unlawful by federal, state, or local laws.
STEP UP IS AN EQUAL OPPORTUNITY EMPLOYER
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