LVN Case Manager Ambulatory Care Beverly Hills, CA

The Cedars-Sinai Medical Network is committed to helping primary care and specialist physicians provide excellent care to all their patients who benefit from convenient access to primary and specialty care physicians and seamless coordination of care between them. As a part of Cedars-Sinai our physicians and staff are partners in quality health care from a medical center that is consistently recognized as one of the finest hospitals in the country. For the 8th consecutive year we have been named one of the top 20 Physician Groups in Southern California by Integrated Healthcare Associates (IHA).
Primary Duties and Responsibilities

Meets with patients within 24 hours of admission and conducts an initial assessment.
Consults with assigned hospitalist each day during morning rounds regarding disposition planning and appropriateness for each day of patients stay
Reviews with hospitalist the patients admission and continued stay for medical necessity appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary.
Begins discharge planning and care assessment within one working day (preferably on day of admission).
Submits necessary clinical information to the health plan using the accepted format (MIDAS or telephonic) and coordinate health plan communication with assigned hospitalist as appropriate.
For patients who are transitioning to the Skilled Nursing Facilities refers to nurse practitioner and case manager assigned to the SNFs for continued review and follow up
Authorizes all appropriate services based upon covered benefits and necessity of care provided
Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate.
Coordinates the patients care with other health care personnel to ensure that the patient receives care timely post discharge.
Secures outpatient follow-up appointments and scheduling tests or outpatient procedures with appropriate health care providers
Refers to Ambulatory Case Manager patients identified that will need oversight of outpatient care and compliance to avoid unnecessary readmissions
Coordinates referrals and secure appointment with various CSMNS disease management programs
Enters and updates all authorization and clinical information into Nautilus (Access Express) no later than date of discharge