Description

Responsible for Care Coordination and Care Transitions Planning throughout the acute care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and transition of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through effective resource coordination. The goals of this role are to include the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self –determination while coordinating in a timely and integrated fashion. He/She collaborates with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and community resources. If assigned to the Emergency Department, the Care Management process is to address complex clinical and social situations efficiently in order to avoid unnecessary admissions.

Qualifications

Education
BS in one of following: Nursing or Health related field required or equivalent education/experience. MS in Nursing, Case management, or related field Required or equivalent education/experience.

Licensures and Certifications
CA RN license required.  Certified Case Manager (CCM) preferred.

Experience
Minimum of three (3) years in acute medical/surgical/ED/critical care nursing area required. Masters of Nursing in Case Management in lieu of three (3) years in acute medical/surgical/ED/ or critical care nursing area may be considered for employment at director’s discretion. Previous Case Management experience preferred. Experience utilizing electronic InterQual or other standardized criteria strongly preferred. .Experience utilizing electronic InterQual or other standardized criteria strongly preferred. Experience with clinical assessment for patient with complex medical, emotional and social needs. Experience using an electronic medical record system Experience and knowledge with MIDAS and Allscripts preferred.

Skills and Knowledge
A broad knowledge base of health care delivery and case management within a managed care environment. Comprehensive knowledge of Utilization Review, levels of care, and observation status. Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems preferred. Working knowledge of laws, regulations, and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS, Title 22, CHA Consent Manual, CDPH and TJC. A broad knowledge base of post-acute levels of care and associated regulatory compliance requirements. General understanding of coding and DRG assignment process preferred. Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners. Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families. Demonstrates commitment to service excellence in all patient, family and employee interactions and in performing all job responsibilities. Functions in a manner to promote quality patient care and assure a positive patient experience. Strong verbal and written communication skills and negotiation skills. Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities. Intermediate computer and technology skills. Ability to promote teamwork and to effectively function in teams. Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience.

• In accordance with state and federal regulations, assists the pharmacist, under direct supervision, in the practice of pharmacy. Assists the pharmacist in the performance of other Pharmacy Department duties in accordance with Company policies and procedures.
• Responsible for using pharmacy systems to obtain patient and drug information and process prescriptions.  If PTCB certified, assists with and coaches pharmacy technicians in the operation of pharmacy systems and cashiers in the operation of the pharmacy cash registers.
• Models and delivers a distinctive and delightful customer experience.

• Engages customers and patients by greeting them and offering assistance with products and services.  Resolves customer issues and answers questions to ensure a positive customer experience.
• Models and shares customer service best practices with all team members to deliver a distinctive and delightful customer experience, including interpersonal habits (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., offering help proactively, identifying needs, servicing until satisfied, etc.).
• Develops strong relationships with most valuable customers.

• Under the supervision by the pharmacist, assist in the practice of pharmacy, in accordance with state, federal, and company policy.  Reviews and complies with the Walgreen Co. Pharmacy Code of Conduct.
• Performs duties as assigned by Pharmacy Manager, Staff Pharmacist and Store Manager including utilizing pharmacy systems to enter patient and drug information, ensuring information is entered correctly,  filling prescriptions by retrieving, counting and pouring pharmaceutical drugs, verifying medicine is correct, and checking for possible interactions.  Assists pharmacists in scheduling and maintaining work flow.
• Reports, immediately, prescription errors to pharmacist on duty and adheres to Company policies and procedures in relation to pharmacy errors and the Quality Improvement Program.
• Strictly adheres to the Walgreen Co. policy regarding Good Faith Dispensing during all applicable prescription dispensing activities.
• Responsible and accountable for registering all related sales on assigned cash register, collects and handles cash as required.  Takes customer to OTC aisle when possible to assist in locating products.
• Handles telephone calls that do not require personal attention of the pharmacist, including those to physicians.
• Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient manner, and performs other clerical duties, as assigned by the Pharmacy Manager.
• Assists and supports Pharmacy Department on inventory management activities, such as, ordering, unpacking, checking and storing shipment of pharmaceuticals.  Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages (merchandise billed, but not received), order errors or damaged goods involving Rx drugs.
• May assist pharmacist in administering clinical services including the collection and proper labeling of blood/urine samples from patients and other clinical services as required; assists pharmacy staff in coordination of clinical services, Walgreens healthcare clinics and external providers.
• Assists Pharmacy Manager and Staff Pharmacist in developing and maintaining good relationships with the local medical community, including physicians, nurses, and other health care providers, by medical provider detailing and outreach to health groups, retirement homes, nursing homes, and other forums for enhancing growth opportunities.
• Assists with exterior and interior maintenance by ensuring the Pharmacy Department is stocked with adequate supplies, clean, neat and orderly in condition and appearance.
• Complies with all company policies and procedures; maintains respectful relationships with coworkers.
• Completes special assignments and other tasks as assigned.

• Earns and maintains PTCB certification through the designated PTCB training program and/or state required certification/registration.  Otherwise, earns PTCB certification as condition of promotion to senior technician.
• Attends training and completes PPLs requested by Manager and acquires continuing education credits.  Maintains knowledge and skill in healthcare and pharmacy, including latest news and developments.