Director of Case Management
3.
5 Quick Apply 8 hours ago Full Job Description Job
Summary:
The Manager of Case Management/Social Services is responsible for providing leadership, management, and administrative direction to the programs, activities, and staff of the CM/SW Department within the Avanti Hospital System.
The Director-Manager has responsibility for the exercise of independent judgment in performing supervisory functions including interviewing and recommending the hiring of new staff members; providing and arranging for training of subordinates; evaluating subordinates' performance; and recommending or approving personnel actions such as promotions, transfers, or disciplinary action and adjudicating grievances to ensure adequate and competent staffing.
This position reports to the Systems Director for Case Management and Social Services.
Behavioral Standards Conducts all activities in compliance with applicable laws and regulations pertaining to abuse, antitrust, employment discrimination, environmental fraud, false claims, lobbying and political activities, self-referral prohibitions and tax.
Ensures compliance with all state and federal regulations related to Case Management and Social Services.
Exercises responsible stewardship to preserve and protect the organization by making prudent and effective use of its resources.
Conduct activities and relationships with others to avoid actual conflict of interest either in fact or appearance.
In the event of conflicts, makes full disclosure and takes appropriate action under Avanti's Conflict of Interest Policy.
Maintains the confidentiality of patient information, protects confidential and proprietary information about associates and the organization.
ESSENTIAL FUNCTIONS 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.
Assists the Systems Director with implementation of programs designed to enhance the quality of patient care, the efficiency of patient management and timely utilization data.
Assists the Systems Director in developing and updating policies, procedures and protocols for department functions.
Provides timely and effective departmental and organizational communication.
Administers the budget for the department.
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.
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.
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.
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.
Quick Apply.
Estimated Salary: $20 to $28 per hour based on qualifications.
5 Quick Apply 8 hours ago Full Job Description Job
Summary:
The Manager of Case Management/Social Services is responsible for providing leadership, management, and administrative direction to the programs, activities, and staff of the CM/SW Department within the Avanti Hospital System.
The Director-Manager has responsibility for the exercise of independent judgment in performing supervisory functions including interviewing and recommending the hiring of new staff members; providing and arranging for training of subordinates; evaluating subordinates' performance; and recommending or approving personnel actions such as promotions, transfers, or disciplinary action and adjudicating grievances to ensure adequate and competent staffing.
This position reports to the Systems Director for Case Management and Social Services.
Behavioral Standards Conducts all activities in compliance with applicable laws and regulations pertaining to abuse, antitrust, employment discrimination, environmental fraud, false claims, lobbying and political activities, self-referral prohibitions and tax.
Ensures compliance with all state and federal regulations related to Case Management and Social Services.
Exercises responsible stewardship to preserve and protect the organization by making prudent and effective use of its resources.
Conduct activities and relationships with others to avoid actual conflict of interest either in fact or appearance.
In the event of conflicts, makes full disclosure and takes appropriate action under Avanti's Conflict of Interest Policy.
Maintains the confidentiality of patient information, protects confidential and proprietary information about associates and the organization.
ESSENTIAL FUNCTIONS 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.
Assists the Systems Director with implementation of programs designed to enhance the quality of patient care, the efficiency of patient management and timely utilization data.
Assists the Systems Director in developing and updating policies, procedures and protocols for department functions.
Provides timely and effective departmental and organizational communication.
Administers the budget for the department.
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.
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.
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.
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.
Quick Apply.
Estimated Salary: $20 to $28 per hour based on qualifications.
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