Clinical Consultant (Registered Nurse)

Overview

We are recruiting for a well versed Registered Nurse (RN) who is interested in joining an administrative setting.The ECM Clinical Consultant is a licensed professional who can act as a clinical resource for the care team, specifically to support non-licensed Lead Care Manager(s). The ECM Clinical Consultant will oversee and manage clinical processes to support the provision of ECM core services. The Clinical Consultant is responsible for supporting the Care Management Team in assessing and addressing members' needs across the continuum of physical, behavioral, and other health and social issues.

Responsibilities

PERFORMANCE AREA 1:

Responsible for ensuring clinical assessment elements leading to the creation of the plan of care are under the direction of an independently licensed clinician.

• Conduct Care Coordination with a minimum of 150 billable hours per month (subject to change with updated department goals and growth).
• Conduct Case Conferences, with a minimum of two conferences per month, and review six patients per conference, billing 12 units per month (Subject to change with updated department goals and growth).
• Account for all billable ECM time by completing documentation in EHR.
• Bill for all ECM care coordination time, ensuring continuous revenue for UHC.
• Provides training and clinical guidance to ECM staff on conducting Comprehensive Assessment and care management planning and care goals for ECM enrolled patients.
• Provides tools and support to the ECM staff to meet productivity goals that support the compliance and productivity goals of UHC.
• Support ECM staff in managing complex and high acuity cases, offering immediate clinical guidance as needed
• Reviews and informs the care team of the recommended care plan based on the results of the assessment.
• Sign off on Comprehensive Assessments and Care Plans on time.
• Serve as a clinical resource for the care team through the development and implementation of care plans.
• Conduct patient follow-ups if patient needs are extending outside the scope of a Lead Care Manager or Community Health Worker (i.e., medication reconciliation)
• Facilitates access to primary care and behavioral health providers, as needed to assist the Lead Care Manager and team.
• Coordinate and prepare for audits from Health Plans and or DHCS.
• When indicated, conduct follow-up visits with ECM-enrolled patients if Lead Care Managers require clinical support among their caseloads.
• Conduct a comprehensive case review and provide final approval for patients/cases that Lead Care Managers are seeking to graduate from the ECM Program
• Meet productivity goals for documentation, time logging, and billing for enrolled ECM patients set by the Population Health Director.

PERFORMANCE AREA 2:

• The ECM Clinical Consultant will oversee the clinical component of the Enhanced Care Management program.
• Monitor ECM staff have current training to ensure clinical assessments and care plans will pass audits from Health Plans or DHCS.
• Coordinate, schedule, and participate in multidisciplinary team meetings in accordance with Health Plans and DHCS.
• Maintains direct communication with the Population Health Director on all clinical ECM activities.
• Ensures that the quality of work is error-free and complete by monitoring the accuracy of documentation of ECM assessments, follow-ups, care plans, and claims. This would include regular audits of staff work and process review.

PERFORMANCE AREA 3: General Corporate Expectations

• Attends and actively participates in all meetings (e.g., department meetings, program meetings, employee staff meetings) and other activities as required or assigned.
• Attends workshops/seminars as necessary to increase skills and knowledge to provide effective care, treatment, and/or leadership.
• Supports the overall needs of the health center by working flexible or extended hours when necessary.
• Demonstrates awareness of, and compliance with, organizational mission and objective of UHC to provide health care access and support services for all members of the community.
• Supports their own staff development by completing the required hours of continuing education each year.
• Other work-related duties as assigned by supervisor. Duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.
• Maintains confidentiality and respect for information regarding patients and other team members; abides by UHC Rules of Confidentiality and general HIPAA regulations regarding privacy.
• Displays a positive, professional and respectful demeanor at all times toward employees, peers, professional contacts, and patients served, maintaining a professional appearance and positive image for the health centers.
• Contributes to the team by promoting positive staff interaction, maintains open communication with other programs/departments.

Qualifications

EDUCATION:

• Appropriate schooling and current licensure for providing professional services (California RN license, LCSW, MD/DO, or NP/PA),

PRIOR EXPERIENCE:

• Experience with Medi-Cal underserved and culturally diverse populations.
• Audit/oversight experience.
• Previous Care Management/Care Coordination Experience.
• Excellent verbal and written communication skills.
• Strong problem-solving, planning, and organizational skills.
• Ability to work as a member of a multidisciplinary team.

The pay range for this Exempt position starts at $85,119.96 a year. Our salary ranges are dependent on knowledge, skills, and experience.

In addition, our comprehensive benefits package for regular status employees includes:

• Medical, Dental, and Vision insurance with low premium cost
• Paid time off and paid holidays
• 401k plan with matching contribution
• Educational Assistance
• Employee discounts and more!