Director, Case Management

Job Duties:

• Provides leadership and management of clinical care coordination, utilization management, discharge planning, and outcomes management.
  


• Oversees the MediCal TAR process...
  


• Manages the systems, processes, and outcomes of clinical care teams and programs designed to address clinical and financial needs of patients and families.
  


• Responsible for goal setting, program planning, work flow processes, regulatory compliance, staff productivity, facilitation of work teams, quality of work, outcome evaluation and continuous quality improvement.
  


• Represents the hospital to internal and external customers, including patients and families, physicians, service line leadership, administration, and health plans.
  


• Maintains professional and collaborative relationships with the hospital administration, staff, physicians, service line administration, other internal and external customers, including health plans, medical groups, patients and families.
  


• Develops and maintains a positive working relationship with the Physician Advisor of the facility to ensure correct patient classifications, timely denials management, and development of collaboration with physician members and other departmental leaders within the hospital.
  


• Participates in Utilization Review Committee functions.
  


• Knowledge of State and Federal Regulations including but not limited to EMTALA, MediCal, Medicare, and HMO’s.
  

Collaboration/Teamwork

• Contributes toward effective, positive working relationships with internal and external colleagues.
  


• Demonstrates cooperation, flexibility, reliability and dependability in all daily work activities.
  


• Demonstrates a willingness to collaborate with others for the good of the customer and the organization.
  

Job Requirements

Knowledge, Skills, Abilities

• Knowledge of the theory, principles, and practices of case management and social services.
  


• Knowledge of patient rights.
  


• Knowledge of principles and practices of management and supervision including planning, organizing, directing, motivating, controlling and decision making.
  


• Ability to communicate effectively with individuals at all levels and from all backgrounds both orally and written.
  


• Ability to set priorities appropriately and handle multiple issues concurrently.
  


• Ability to establish and monitor departmental and corporate goals.
  


• Ability to motivate subordinates to work effectively and efficiently.
  


• Possess strong critical thinking skills with the ability to work independently as well as in teams.
  

Education/Experience

• Baccalaureate in Nursing strongly preferred. Master’s degree a strong plus.
  


• Minimum of three years in acute care Case Management preferably in a leadership role.
  


• Valid RN License in the State of California.
  


• Current BLS Card issued by the American Heart Association.
  


• ACM preferred.
  


• McKesson InterQual experience preferred.
  

ADA/Physical Demands

• To perform this job successfully, and individual must be able to perform each essential job duty satisfactorily. The requirements listed are representative of the knowledge, skill and ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant in order to be considered.
  


• Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch or crawl; talk and hear; and may taste and smell. The employee is regularly required to lift, push and or pull weights in excess of 10 pounds with assistance. Visual abilities, auditory abilities must be intact to perform duties.
  

Requirements

Education/Experience

• Baccalaureate in Nursing strongly preferred. Master’s degree a strong plus.
  


• Minimum of three years in acute care Case Management preferably in a leadership role.
  


• Valid RN License in the State of California.
  


• Current BLS Card issued by the American Heart Association.
  


• ACM preferred.
  


• McKesson InterQual experience preferred.