Manager, Care Management

Job Summary

The Manager reports to the Director of the Case Management and Social Work Department and is responsible for providing (24/7) leadership and management of case management, social work, utilization management, and discharge planning. The Manager assists the Director with processes and outcomes of clinical care teams and programs designed to address patients and families' clinical, psychosocial, and financial needs.

Scope of Responsibilities

• Training, supervision, and evaluation of team members
• Participation in goal setting, program planning, workflow process monitoring, regulatory compliance, staff productivity assessment, good customer service, quality of work, outcome evaluation, and continuous quality improvement
• Representing Henry Mayo Newhall Hospital to internal and external customers, including patients and family physicians, ancillary medical personnel, administration, health plans, and third-party payors

Qualifications

• Comprehensive knowledge of laws, regulations, and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS, Title 22, CHA Consent Manual, and TJC
• Knowledge of ACMA, CMSA, and NASW Standards of Practice
• Excellent verbal and written communication skills
• Ability to promote teamwork and to effectively function in teams, both as a leader and as a team member
• Working knowledge of Meditech and Inter-Qual Criteria
• Ability to interact effectively with key internal and external constituents using collaboration, negotiation, and analytical problem resolution skills
• Demonstrated ability to implement continuous quality improvement processes and techniques, including benchmarking and outcomes measurements
• PC skills, word processing, spreadsheets, and managed care software programs

Skills

• Licenses and Certifications:
• Current California RN License
• Current BLS Provider Care
• National certification from ANCC, ACMA, or Case Management Association of America preferred
• Education:
• Bachelor’s degree in Nursing required
• Master’s degree preferred
• Experience:
• Experience leading innovative case management programs
• Experience in utilization management and discharge planning
• Leadership experience in acute case management
• Experience with clinical assessment for clients with complex medical, emotional, and social needs
• Experience planning, leading, and organizing the resources of a team
• Strong problem resolution abilities and customer relation skills