Deputy Director-Case Management

Approximate salary: $174,359.03 - $211,934.49/year. Full-time position.

About the role

San Joaquin General Hospital is offering an excellent employment opportunity for a motivated leader with a passion to serve economically and diverse communities. The ideal candidate has demonstrated case management experience in an acute care hospital setting, strong administrative skills, and excellent oral and written communication abilities.

Final appointment will be conditional upon passing a drug screening test, DOJ Live Scan fingerprinting, and a background investigation.

Responsibilities

• Plans, organizes, and directs patient care coordination activities for a select group of patients with complex diagnoses and healthcare needs.
• Directs development and implementation of facility-wide care transitions, discharge planning, and utilization standards to ensure coordinated treatment plans, customer-focused service delivery, and cost-effective utilization of necessary services.
• Establishes and implements a Case Management program in compliance with federal, state, county, and contracted agencies’ regulatory mandates and laws.
• Oversees the development of department standards as identified by regulatory agencies, including The Joint Commission, and maintains continuous regulatory readiness.
• Interprets federal and state regulations, contracts, and agreements related to utilization review and inpatient reimbursement.
• Maintains oversight and monitors effectiveness of concurrent and retrospective inpatient reviews, appeal processes, discharge planning, and transition of care services; conducts quality and compliance audits of casework.
• Coordinates with the Physician Chairman of the Utilization Review Committee to meet Joint Commission requirements; educates physicians and hospital staff.
• Collaborates and develops effective working relationships with physicians, multidisciplinary teams, and community entities to ensure timely and coordinated discharge planning; negotiates contracts with external providers and community partners.
• Trains and develops Case Management staff to accomplish department goals; ensures efficient use of resources, and oversees screening, hiring, training, and competency maintenance of subordinate staff.
• Provides oversight and monitoring of the assigned budget area, analyzes data, and performs cost analysis as needed.
• Identifies and implements resource reduction strategies consistent with the facility’s strategic plan, focusing on quality outcomes, reduction of length of stay, medical necessity, and appropriate levels of care.
• Participates in leadership activities to drive quality, performance improvement, consistency of operations, and cost-efficiency.
• Works toward reducing administrative, avoidable, and denied days; provides secondary review of cases that do not meet established criteria.
• Provides information regarding changes in Medi-Cal and Medicare regulations and documentation issues to physicians, nurses, and others as needed.
• Establishes, prioritizes, and meets utilization goals; monitors utilization indicators; identifies and escalates issues; initiates and evaluates action plans for achieving goals and targets.

Requirements

Knowledge

• Principles and practices of supervision, staff development, organization, administration, fiscal, and program management.
• Budget preparation and monitoring.
• Principles and practices of nursing and patient care services for care management, discharge planning, and utilization management in an acute healthcare setting.
• Federal and state healthcare laws and regulations common to the operation of hospitals in California.
• Financial processes of various private and public funding sources.
• Regulations of intermediary agencies pertaining to hospital stay coverage (e.g., Medicare/Medi-Cal).
• Principles and applications of hospital information systems as they relate to care management and utilization review.
• Criteria for level of care and current standards in medical and nursing practice.
• Available alternative patient services and treatments.
• English usage, style, grammar, punctuation, and spelling.
• Common computer systems and applications.

Abilities

• Exercise analytical and critical thinking skills; make sound managerial decisions.
• Provide effective and efficient management advice in a high-paced environment.
• Serve as a resource to physicians, nurses, and care management staff.
• Keep abreast of, understand, interpret, apply, and implement healthcare laws, rules, regulations, and procedures.
• Evaluate data and statistics and prepare reports.
• Select, train, supervise, develop, evaluate, discipline, and motivate staff.
• Work effectively as a member of a management team in a large healthcare organization.
• Establish and maintain effective working relationships with colleagues, the public, and representatives of other agencies.
• Communicate effectively, both orally and in writing, with people of diverse backgrounds and cultures.

Physical/Mental Requirements

• Mobility: Frequent operation of data entry device; occasional standing and walking; frequent driving and sitting may be required.
• Lifting: Occasional lifting of 5 to 10 pounds.
• Vision: Frequent hand-eye coordination, depth perception, reading, and close-up work.
• Dexterity: Normal dexterity with occasional writing.
• Hearing/Talking: Constant hearing and talking on the telephone, radio, and in person.
• Emotional/Psychological: Constant decision-making with frequent concentration required.
• Special Requirements: May occasionally work weekends/nights; may be required to travel.
• Environmental Conditions: Occasional exposure to noise.

Benefits

• Health Insurance: Comprehensive benefits package with four medical plan options: Kaiser HMO, Sutter Health Plus HMO, and two self-funded PPO plans (Select Plan and Premier Plan). Employees pay a portion of the premium; dependent coverage is available.
• Dental Insurance: Choice of four dental plans: three through Delta Dental and one through United Health Care-Select Managed Care Direct Compensation Plan. The County pays the full premium for all but one Delta Dental Plan (Buy-up), which the employee pays at a slightly higher cost. Dependent coverage is available at the employee’s expense.
• Vision Insurance: Two vision plan options through Vision Service Plan (VSP). No cost for the base plan at employee-only coverage; buy-up plan option has a slightly higher cost. Dependent coverage is available at the employee’s expense.
• Life Insurance: Coverage provided as follows:
  • 1 but less than 3 years of continuous service: $1,000
  • 3 but less than 5 years of continuous service: $3,000
  • 5 but less than 10 years of continuous service: $5,000
  • 10 years of continuous service or more: $10,000
  Regular employees receive a supplemental life insurance policy with a face value up to $75,000. Employees may purchase additional term life insurance up to a maximum of $200,000 at the group rate.
• Section 125 Flexible Benefits Plan: Voluntary program allowing employees to use pre-tax dollars for health-related expenses not covered by medical, dental, or vision plans, and for dependent care costs. Annual limits are set by the IRS.
• Retirement Plan: Employees are covered by the County Retirement Act of 1937. For more information, visit SJCERA.
• Deferred Compensation: The County maintains a deferred compensation plan under Section 457 of the IRS code. Employees may contribute up to $22,500 annually (or 100% of includible compensation, whichever is less). Individuals age 50 or older may contribute up to $30,000. The Roth IRA (after-tax) option is also available. The County contributes 2% of the employee’s base salary to the deferred compensation plan for members of this unit.
• Vacation: Maximum earned vacation is 15 days each year up to 10 years of service; 20 days after 10 years.