Manager, Care Management
5 days ago
Summary
Alameda Health System offers outstanding benefits that include:
* 100% employer health plan for employees and their eligible dependents
* Unique benefit offerings that are partially or 100% employer paid
* Rich and varied retirement plans and the ability to participate in multiple plans.
* Generous paid time off plans
Role Overview:
Alameda Health System is hiring The Manager of Care Management is responsible for the day-to-day operations of facility wide utilization, discharge planning and care coordination.
DUTIES & ESSENTIAL JOB FUNCTIONS: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by everyone in the classification.
-Assists Director in Establishing, implementing, and ensuring that care management policies, practices and procedures are in accordance with the Joint Commission, Title 22 and other regulatory agencies and overall hospital policies.
-Conducts and records periodic staff meetings, to inform staff of changes in policies and procedures.
-Conducts interdepartmental team conferences for identifying aberrant utilization; establishes a method of tracking variances based on critical timelines.
-Develops and provides statistical UM information and reports to appropriate committees and in conjunction with the Director of Care Management identifies utilization issues affecting the quality of patient care.
-Direct and coordinate data gathering and record keeping legally required by Federal and State agencies, the Joint Commission, and hospital policies; participates in the risk mitigation, process of implementing new or revised processes, and projects.
-In conjunction with VP and Director, coordinates, develops, and implements action plans to respond to areas felt to need improvement related to patient flow and care coordination across the continuum.
-Manages and assumes responsibility for day-to-day operations of utilization management, care coordination and discharge planning activities.
-Manages process of pre-admission review of questionable admissions as referred by Admitting, Emergency Room and medical staff and offers workable solutions.
-Oversees submission of any audits, including but not limited to MediCal, Medicare and internal compliance studies.
-Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals. Maintains minimal denial rates by Medicare, MediCal, private and contracted payors through appropriate direction of utilization practices; assists physicians and hospital personnel in understanding care management issues.
-Perform all other duties as assigned.
-Performs daily clinical rounds and monthly audit of charts on care management activities (utilization review, discharge planning and Interrater Reliability).
-Prepares cost analysis reports and other data needed for the preparation of the departmental budget.
-Provides in house educational programs as needed for both staff and physicians.
-Responsible for the recruitment, orientation, evaluation, counseling and disciplinary action of care management clinical and administrative staff.
-Responsible to purchase, educate, and record education to new equipment and/or techniques.
-Reviews cases regularly with staff; acts as clinical consultant regarding care management issues; guides clinical staff with review of assessments and care plans, evaluates utilization reviews or documentation.
-Serves as a content expert to staff and internal departments and external partners; networks with other hospitals, nursing organizations, and professional organizations to keep abreast of changes within the profession.
-Supervises technical procedures and performs procedures as needed.
MINIMUM QUALIFICATIONS:
Preferred Licenses/Certifications : Certification in Case Management, CCMC or ACM.
Preferred Education : Master's in Nursing or Masters in Social Work or related field.
Required Experience: Five years of clinical nursing or social work experience in a directly related setting (e.g., acute care, skilled nursing, etc.); three years of case management experience; two years of experience in a supervisory or lead role.
Required Licenses/Certifications : Active licensure as a Registered Nurse in the State of California or licensed in Clinical Social Work in California, Active BLS - Basic Life Support Certification issued by the American Heart Association. Other advanced life support certifications may be required per unit/department specialty according to patient care policies. CPI -Crisis Prevention Intervention Training (required for all positions at John George Psychiatric Pavilion; and certain positions in the Emergency Department
Highland General Hospital
HGH Care Coordination
Full Time
Day
Management
FTE: 1
-
Manager Care Management
3 months ago
Glendale, CA, United States Clinical Management Consultants Full timeA large medical facility in Los Angeles is looking to bring on a new Manager Care Management to join their team of medical professionals. This hospital has about 150+ beds with 350 employees onsite. This highly accredited hospital is known for their strong dedication to the best quality of patient care. The Manager Care Management is responsible for...
-
Manager, Care Management
1 hour ago
Oakland, CA, United States Alameda Health System Full timeSummary Alameda Health System offers great benefits to our employees! * 100% employer health plan for employees and their eligible dependents * Unique benefit offerings that are partially or 100% employer paid * Rich and varied retirement plans and the ability to participate in multiple plans. * Generous paid time off plans Role Overview: The Manager of...
-
Manager, Care Management
3 months ago
Oakland, CA, United States Alameda Health System Full timeSummary Alameda Health System offers outstanding benefits that include: 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer paid Rich and varied retirement plans and the ability to participate in multiple plans. Generous paid time off plans Role Overview: Alameda Health...
-
Manager, Care Management
3 months ago
Oakland, CA, United States Alameda Health System Full timeSummary Alameda Health System offers great benefits to our employees! 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer paid Rich and varied retirement plans and the ability to participate in multiple plans. Generous paid time off plans Role Overview: The Manager of...
-
District Manager
1 month ago
Battle Creek, MI, United States District Manager Full timeDescription Using your past leadership experience, you will: Grow a portfolio of successful businesses: Develop district-level strategies to achieve each restaurant’s financial, operational and customer-service goals, while addressing each unit’s unique strengths and challenges. Develop and execute store level plans that build sales, increase...
-
Care Management Specialist
5 days ago
Oakland, CA, United States Alameda Health System Full timeSummary SUMMARY: Assists in Care Management Team of social workers and nurses with functions such as but not limited to provide census reconciliation, administrative support for care coordination and discharge planning activities, working with the payors, accurate and critical information data entry and tracking, and report creation. DUTIES & ESSENTIAL JOB...
-
Community Association Manager
2 weeks ago
Oakland, CA, United States Prime HOA Management Full timeWe are growing!Our company manages homeowners associations around the Bay Area and Sacramento. We are looking for a skilled community association manager to manage a portfolio of HOAs and provide excellent customer service.Position Overview: The Community Association Manager (CAM) manages and oversees the day-to-day operations of residential communities,...
-
Nurse, Care Management
5 days ago
Oakland, CA, United States Alameda Health System Full timeSummary SUMMARY: Responsible for coordinating continuum of care and discharge planning activities for a caseload of assigned patients; develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, and identifies cost-effective protocols. Care Management provides Care Coordination,...
-
Manager, Spiritual Care
5 days ago
Oakland, CA, United States Alameda Health System Full timeSummary SUMMARY: T he Manager, Spiritual Care Department, plans, administers, manages, supports, advocates for, and evaluates the activities and staff of the Spiritual Care Department at Alameda, San Leandro, Fairmont, and Wilma Chan Highland Hospitals. The incumbent is responsible for the daily operation of the Spiritual Care Department, providing the full...
-
Nurse, Care Management
3 months ago
Oakland, CA, United States Alameda Health System Full timeSummary SUMMARY: Responsible for coordinating continuum of care and discharge planning activities for a caseload of assigned patients; develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, and identifies cost-effective protocols. Care Management provides Care Coordination,...
-
Nurse Manager Ambulatory Care Services
6 days ago
Sacramento, CA, United States Clinical Management Consultants Full timeAn excellent opportunity is now available for an Outpatient Specialty Clinics Nurse Manager to join our growing healthcare organization in the Sacramento Valley. The Clinical Nurse Manager Outpatient Specialty Services will report to the Regional Director of Outpatient Services. The Nurse Manager Outpatient Clinical Services will be responsible for managing...
-
Nurse Manager Ambulatory Care Services
5 days ago
Sacramento, CA, United States Clinical Management Consultants Full timeAn excellent opportunity is now available for an Outpatient Specialty Clinics Nurse Manager to join our growing healthcare organization in the Sacramento Valley. The Clinical Nurse Manager Outpatient Specialty Services will report to the Regional Director of Outpatient Services. The Nurse Manager Outpatient Clinical Services will be responsible for managing...
-
Manager, Spiritual Care
3 months ago
Oakland, CA, United States Alameda Health System Full timeSummary SUMMARY: T he Manager, Spiritual Care Department, plans, administers, manages, supports, advocates for, and evaluates the activities and staff of the Spiritual Care Department at Alameda, San Leandro, Fairmont, and Wilma Chan Highland Hospitals. The incumbent is responsible for the daily operation of the Spiritual Care Department, providing...
-
Care Management Manager
1 month ago
Oakland, California, United States Alameda Health System Full timeJob Title: Care Management ManagerAlameda Health System is seeking a highly skilled Care Management Manager to oversee the day-to-day operations of facility-wide utilization, discharge planning, and care coordination.Key Responsibilities:Assist in establishing, implementing, and ensuring that care management policies, practices, and procedures are in...
-
Lead Care Manager
1 month ago
Los Angeles, CA, United States Akido Care Full timeJob Description The Lead Care Manager (LCM) will support members with complex medical and social needs with managing their own health and wellbeing. LCM will assist in motivating behavioral changes in patients to improve health outcomes in members through education, peer support, and the relaying of shared experiences. Responsibilities: Manage a caseload of...
-
Manager, Care Management
1 month ago
Oakland, United States Alameda Health System Full timeSummary Alameda Health System offers outstanding benefits that include: 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer paid Rich and varied retirement plans and the ability to participate in multiple plans. Generous paid time off plans Role Overview: Alameda...
-
Manager, Care Management
1 month ago
Oakland, United States Alameda Health System Full timeSummary Alameda Health System offers great benefits to our employees! 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer paid Rich and varied retirement plans and the ability to participate in multiple plans. Generous paid time off plans Role Overview:The Manager...
-
Manager, Care Management
4 months ago
OAKLAND, United States Alameda Health System Full timeSummary Alameda Health System offers outstanding benefits that include: 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer paid Rich and varied retirement plans and the ability to participate in multiple plans. Generous paid time off plans Role Overview: Alameda...
-
Manager, Care Management
3 months ago
Oakland, United States Alameda Health System Full timeSummary Alameda Health System offers great benefits to our employees! 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer paid Rich and varied retirement plans and the ability to participate in multiple plans. Generous paid time off plans Role Overview:The Manager...
-
Manager, Care Management
3 weeks ago
Oakland, United States Alameda Health System Full timeSummary Alameda Health System offers outstanding benefits that include: 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer paid Rich and varied retirement plans and the ability to participate in multiple plans. Generous paid time off plans Role Overview: Alameda Health...
