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Organ Transplant Manager, Bakersfield, CA


Organization: Kern Health Systems
Category: Manager
Location: Bakersfield, CA
Date Job Posted: August 31, 2021
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Organ Transplant Manager

Req #1597

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

Primary Purpose

Under direction of the Kern Health Systems (KHS) Director of Population Health Management, the Major Organ Transplant Manager is responsible for provision and oversight of complex case management (CCM) specific to KHS members eligible for Major Organ Transplantation. Complex case management within KHS is defined as the coordination of care and services for members who need help navigating the healthcare system to facilitate the appropriate delivery of care and services. These services are provided utilizing available resources across a continuum of care and in collaboration with members, caregivers, providers, hospitals, and ancillary health care providers.

The Major Organ Transplant Manager employs a variety of strategies, approaches, and techniques to manage the transplant member's physical, environmental and psycho-social health issues. The Major Organ Transplant Manager ensures each patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations through the member specific care plans.

Distinguishing Characteristics

The Major Organ Transplant Manager’s work assignments are varied and frequently require direct communication with patients, providers, interpretation and independent determination of the appropriate courses of action.

Supervises Yes

Essential Functions

  • Provide network education & clinical guidance on transplant process;
  • Serve as the member and provider single point of contact for all transplant services;
  • Guide members by providing information and resources that enable the member to make informed decisions;
  • Educate the member on their benefits, and guide the member to maximize their transplant benefit;
  • Liaison with all Transplant Centers of Excellence to assist with benefit maximization;
  • Work tasks assigned in the clinical documentation system and update as appropriate;
  • Lead role in education of family and addressing possible barriers to home transition
  • Organizes and leads ICT and facilitate care coordination and notification to providers;
  • As KHS MOT content expert (SME) with review and update HS department on changes in requirements and processes related to MOT.

Core Competencies/Knowledge & Skill Requirement

  • Lead by example to support a positive work environment that values patient advocacy, respectful listening, diverse expression of opinion and constructive conflict resolution;
  • Adheres to KHS’s Code of Ethics and Business Conduct and all company policies, e.g., confidentiality, attendance, safety/security, use of equipment and technology, appearance and demeanor;
  • Represent KHS in a positive manner to all members, caregivers, staff and external stakeholders;
  • Demonstrate commitment to continuous improvement;
  • Strong knowledge of acute chronic care nursing principles, methods and common treatments;
  • Strong knowledge of common human diseases and usual and customary methods of treatments;
  • Demonstrated knowledge of medical terminology;
  • Ability to effectively evaluate medical records to determine appropriateness and necessity of care;
  • Demonstrated knowledge of health care delivery systems;
  • Very strong interpersonal skills, including the ability to establish and maintain effective working relationships with individual at all levels both inside and outside of KHS;
  • Ability to use tact and diplomacy to diffuse emotional situations;
  • Effective oral and written communication skills, including the ability to effectively explain complex information and document according to standards;
  • Intermediate skills in Word and Excel with basic ability to enter data into and navigate through a database;
  • Demonstrated ability to respect and maintain the confidentiality of all sensitive documents, records, discussions and other information generated in connection with activities conducted in, or related to, patient healthcare, KHS business or employee information and make no disclosure of such information except as required in the conduct of business;
  • Demonstrated ability to commit to and facilitate an atmosphere of collaboration and teamwork;
  • Self-directed, with proven ability to work independently with minimum supervision;
  • Demonstrated ability to multi-task in an interrupt-driven environment and complete assignments on a timely basis;
  • Strong attention to detail; work accurately and at a reasonable rate of speed;
  • Compliant with KHS policies and procedures; performs the job safely and with respect to others, to property, and to individual safety;
  • Identify members who are considered high risk for medical care resource utilization;
  • Conducts assessments to identify the member’s needs and develops a specific care plan to address objectives, barriers, and goals identified during the assessment;
  • Monitors and evaluates the effectiveness of the care plan and modifies as necessary;
  • Comprehensively identify strengths and opportunities for members, including physical, behavioral and social support system capacities and degree of engagement with providers;
  • Provides education and coordination of outpatient care to KHS members selected for Transplant Case Management;
  • Identifies and refers quality of care, coordination of benefits, and third-party liability issues as appropriate;
  • Develops collaborative action plans with clearly identified, achievable objectives, focused on modifiable risk factors,
  • Recognize members’ right to participate or refuse treatment;
  • Participates in and facilitates, as needed, care management conferences with members, providers, and other specialist and/or ancillary providers;
  • Document all care plan notes in accordance with professional standards in a thorough and timely manner;
  • Communicate, consult, and collaborate with KHS Chief Medical Officer and/or Medical Director on an as needed basis
  • Serve as a liaison to community providers and KHS Members;
  • Collaborate with KHS staff to facilitate production of reporting necessary to obtain statistics to monitor, establish and identify member care needs;
  • Provide written and verbal communication with contract providers and KHS staff to promote appropriate and timely coordination of care;
  • Perform other related duties and special projects as assigned;

EMPLOYMENT STANDARDS:

Education:

  • Bachelor’s Degree in Nursing from an accredited school or equivalent, Health Administration or related healthcare field required;
  • Possession of active California Registered Nurse (RN) License;
  • Certified Case Manager (CCM) preferred;

Experience:

  • Minimum of five (5) or more years of clinical nursing experience working with patients and caregivers regarding self-care and disease management required; AND
  • Two (2) or more years of experience as an RN in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company required;
  • One (1) or more years of Transplant experience working as an RN required;

Knowledge of:

  • Knowledge of Transplant process and workflow for all phases-referral/evaluation, listed, transplantation, and post transplantation for up to 12 months;
  • Managed care health plan, case management or care coordination experience is a plus;
  • Knowledge of MCG Evidence based criteria;
  • Proficient with various health information systems/electronic medical record navigation; Microsoft Office Suite including Visio;

Other

  • Possession of valid California Driver’s License and proof of valid State required auto liability; insurance. (E) Required travel up to 10%;
  • Bilingual (English/Spanish) preferred;

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.

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