RN Manager of Case Management - Hospital
Los Angeles, CA (downtown)
$$$ Generous Relocation Package available to attract top-talent from around the Nation! $$$
Your Job Summary:
The Manager of Case Management provides clinical leadership for all Case Management programs by serving as an educator, role model, member advocate, and change agent to enhance patient care and staff competency. Responsible for the programmatic development, planning, organization, and management of the functions that focus on care facilitation and movement of patients through the hospital continuum. This includes Case Management, Social Work, Utilization Management, and Post-Acute services. The Manager directs daily team operations and provides strong leadership through training, coaching, teaching, and managing assigned teams and departments.
Valid, unrestricted state Registered Nurse (R.N.) license and BSN; Master's degree preferred.
Minimum of 3-5 year’s Case Management experience; Certified Case Manager, (CCM) preferred.
Around 3 year’s managerial experience and leadership of a Case Management staff within a managed care or hospital environment.
Roughly 3-4 years of recent acute care clinical nursing experience, preferably in med/surg, pediatrics, OB, or as leader.
Prefer 5 or more years of case management experience, ideally with a strong acute care CM background with more recent managed care CM experience.
Familiarity with Medicaid managed care practices and policies, CHIP, and SCHIP.
Ability to analyze and integrate information and make sound decisions based upon established guidelines.
Resourcefulness as demonstrated by the effective application of professional knowledge to new situations. Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
Experience in training / teaching staffs to meet operational requirements and goals.
Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
Provides clinical guidance and supervision to all case management programs, based on accepted principles of nursing, social work, gerontology, geriatrics and case management practice. Provides clinical perspective and best practices to staff through one-on-one coaching, group interaction, and at in-service training or other team meetings.
Manages a staff and monitors department activities to evaluate the productivity and quality of programs and processes in order to identify potential improvements and to ensure maximum performance. Develops, manages and participates in departmental projects, workflow processes, policies and procedures in collaboration with internal and external stakeholders. Ensures availability of specialized expertise to Managed Care programs by identifying case management needs and identifying and training subject matter experts. Develops and maintains professional networks and individual relationships with associated health plans, vendors, affiliated hospitals, physicians, and other providers in order to promote continuity and quality of care. Collaborates with staff and leadership to develop and implement systems that support operations and business goals within identified areas of responsibility. Maintains professional and clinical relationships with Medical Directors, AMDs, UM Manager, and the Director of Healthcare Delivery; regularly discussing any concerns regarding utilization of services or complicated cases. Uses a collaborative approach with the case management team in order to revise, develop, and implement cost savings methodologies and interventions. Facilitates communication with providers to ensure continuity of care and coordination between health plans and multiple specialists, providers, and vendors.