Job Description
Torrance Health IPA is currently accepting applications for an Ambulatory
Care Manager, RN (ACM) to join our team. We are an Independent Physician
Practice Association (IPA) affiliated with Torrance Memorial Medical Center,
an award winning hospital located in the South Bay area of Los Angeles County.
The Ambulatory Care Manager RN (ACM) coordinates and monitors the health
needs of members, such as pain, symptom management, behavioral health,
DME’s, home health, assistance with daily living, and/or community
resources. The Care Manager works closely with members, caregivers, family
members, physicians, hospital care managers, and ancillary service providers
to achieve the member’s maximum functional potential. This position
provides on-going support through comprehensive assessment and care planning.
The care manager ensures member’s cases are in compliance with regulatory
guidelines.
Primary Duties and Responsibilities:
- Conducts a comprehensive assessment of member’s health status, activities
of daily living, psychosocial, cultural and linguistic needs, available
benefits and resources, caregiver resources, life planning activities
and community resources via phone or in-person
- Creates an individualized care plan that meets member needs; includes prioritized
goals, development of schedules for follow-up and communication with member
of self-management plan
- Documents member’s assessments, care plans, goals and interventions
in electronic medical management system according to NCQA standards
- Evaluates member’s progress against care plans, goals, interventions
and modifications as needed
- Communicates and coordinate services with member and member’s care
team, such as Primary Care Physician (PCP), specialists, medical providers,
and ancillary providers as necessary to meet member’s medical and
psychosocial needs
- Facilitates member access to behavioral health, social services and community
based services as needed
- Monitors changes in member’s health status and updates documentation
including care plan, care plan goals and modifications in care plan as needed
- Actively participate in Interdisciplinary Care Team Meetings
- Performs in-home assessments as needed
- Performs other related duties, as requested