Baccalaureate in Nursing strongly preferred, Master's degree a plus.
Minimum three years in acute care Case Management, ideally with leadership experience.
Valid RN License in California required.
Current American Heart Association BLS certification needed.
ACM certification preferred; experience with McKesson InterQual is a plus.
Responsibilities
Lead and manage clinical care coordination and utilization management processes.
Oversee MediCal TAR processes and ensure compliance with regulations.
Manage systems and outcomes for clinical care teams addressing patient needs.
Set goals and plan programs to improve workflow and staff productivity.
Represent the hospital to various stakeholders, including patients and families.
Maintain collaborative relationships with internal and external stakeholders.
Develop working relationships with Physician Advisors for better patient management.
Participate in Utilization Review Committee functions.
Benefits
Collaborative work environment with internal and external colleagues.
Opportunities for professional development and continuing education.
Supportive administrative team for goal achievements.
Access to resources for effective care coordination.
Full Job Description
Job Description Job Duties:
Provides leadership and management of clinical carecoordination, utilization management, discharge planning, and outcomesmanagement.
Oversees the MediCal TAR process...
Manages the systems, processes, and outcomes ofclinical care teams and programs designed to address clinical andfinancial needs of patients and families.
Responsible for goal setting, program planning, workflow processes, regulatory compliance, staff productivity, facilitation ofwork teams, quality of work, outcome evaluation and continuous qualityimprovement.
Represents the hospital to internal and externalcustomers, including patients and families, physicians, service lineleadership, administration, and health plans.
Maintains professional and collaborative relationshipswith the hospital administration, staff, physicians, service lineadministration, other internal and external customers, including healthplans, medical groups, patients and families.
Develops and maintains a positive working relationshipwith the Physician Advisor of the facility to ensure correct patientclassifications, timely denials management, and development ofcollaboration with physician members and other departmental leaders withinthe hospital.
Participates in Utilization Review Committee functions.
Knowledge of State and Federal Regulations includingbut not limited to EMTALA, MediCal, Medicare, and HMO's.
Collaboration/Teamwork
Contributes toward effective, positive workingrelationships with internal and external colleagues.
Demonstrates cooperation, flexibility, reliability anddependability in all daily work activities.
Demonstrates a willingness to collaborate with othersfor the good of the customer and the organization.
Job Requirements
Knowledge, Skills, Abilities
Knowledge of the theory, principles, and practices ofcase management and social services.
Knowledge of patient rights.
Knowledge of principles and practices of management andsupervision including planning, organizing, directing, motivating,controlling and decision making.
Ability to communicate effectively with individuals atall levels and from all backgrounds both orally and written.
Ability to set priorities appropriately and handlemultiple issues concurrently.
Ability to establish and monitor departmental andcorporate goals.
Ability to motivate subordinates to work effectivelyand efficiently.
Possess strong critical thinking skills with theability to work independently as well as in teams.
Education/Experience
Baccalaureate in Nursing strongly preferred. Master'sdegree a strong plus.
Minimum of three years in acute care Case Managementpreferably in a leadership role.
Valid RN License in the State of California.
Current BLS Card issued by the American HeartAssociation.
ACM preferred.
McKesson InterQual experience preferred.
ADA/Physical Demands
To perform this job successfully, and individual mustbe able to perform each essential job duty satisfactorily. Therequirements listed are representative of the knowledge, skill and abilityrequired. Reasonable accommodation may be made to enable individuals withdisabilities to perform the essential functions. Such accommodations mustbe 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 requiredto 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'sdegree a strong plus.
Minimum of three years in acute care Case Managementpreferably in a leadership role.
Valid RN License in the State of California.
Current BLS Card issued by the American HeartAssociation.
