Overview

overview

REQUIRED LICENSURE(S)/CERTIFICATIONS: • Current California Registered Nursing License (Required) • Current Certification of Case Management (CCM) (Strongly Preferred) • Current California Licensed Clinical Social Worker or Registered Nurse License (Required) MUST-HAVES/WHAT YOU NEED TO KNOW: • Valid California Registered Nurse license • Minimum of three years of experience of acute care hospital case management is required. • “We need someone with previous in hospital director experience for this position.” • Minimum of 3-5 years’ experience in supervisor or administrative setting required • Current California Licensed Clinical Social Worker or Registered Nurse License (Required) • Knowledgeable about CMS, Managed Care, California Medi-Cal guidelines and California Health Benefit Exchange Regulations JOB RESPONSIBILITIES: • Accountable for Patient Care Coordination activities including system-wide Case Management and Discharge Planning. • Aligns Case Management with client’s strategic and operational objectives. • Develops, monitors and evaluates Case Management Metrics (InterQual). • Initiates data-driven process improvements. • Optimizes efficient Case Management roles and processes. • Integrates managed care contract criteria into overall Case Management functions. • Maintains Case Management regulatory compliance to include CMS, Total Joint Commission and California State Regulations. POSITION SUMMARY: • Under the direction of the Chief Nursing Officer (CNO) or designee, the Case Management Director develops and implements case management programs, including utilization review, intake or discharge planning, and managed care contracting. • Evaluates patient care data to ensure that care is provided in accordance with clinical guidelines and organizational standards. • Seeks treatments that balance clinical and financial concerns with the family’s needs and patient’s quality of life. • Contributes to the development of strategic planning for the program to ensure coordination of goals and targets for both the clinical operations and the organization’s. • Guides and is fully accountable for all department activities to support hospital wide strategic objectives.