Director, Inpatient System Care Management
2 weeks 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 Under the direction of the Vice President of Care Management, the Director of Inpatient System Care Management manages the day to day operations of the inpatient Care Management across all AHS facilities, including post acute care facility for ensuring efficient patient flow, beginning when a patient is admitted to the facility and ending with a safe and clinically appropriate discharge.
DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: 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 each individual in the classification.
- Accountable for Patient Care Coordination activities including system-wide Case Management, Care Coordination and Discharge Planning.
- Aligns Case Management with AHS strategic and operational objectives.
- Optimizes efficient Care Management/care coordination roles and processes; initiates process improvements.
- Develops, monitors and evaluates inpatient Care Management Metrics; manages the collection, analysis and presentation data relevant to the utilization of healthcare resources including but not limited to avoidable/variance days, readmissions, one-day stays, DRGs, LOS.
- Develops, maintains and implements Case Management policies, practices and procedures in accordance with CMS, CA DCHS, the Joint Commission, Title 22 and other regulatory agencies and overall hospital policies; integrates managed care contract criteria into overall Case Management functions.
- Works closely with the VP of Care Management and Physician Advisors on any audits and secondary reviews; may include but not limited to Direct and coordinate data gathering, chart audits and participants in internal and external meetings.
- Oversees educational needs and plan for inpatient Care Management division.
- Recruits, trains and coaches the management staff to assist them with performing optimally and provides appropriate discipline/structure; consults and assists Care Management managers with problem solving with staffing, personnel issues, budget issues and resource management; reviews and evaluates management staff performance, initiate personnel transactions and meet hospital standard for performance evaluations.
- Supports the VP of CM with completion of financial analyses including cost of care to reimbursement, denials management, and non-reimbursed services, promoting effective resource utilization, clinical documentation/queries quality care and patient safety; oversees the Inpatient recovery process; works closely with Revenue Cycle and AHS Physician Advisors; regularly communicates with payors and/or their contracted vendors.
- Responsible for the coordination and support of the AHS Utilization Review Committee.
- Responsible of overseeing patient, physician and staff satisfaction based on quality outcomes and patient experience reporting; in conjunction with the Quality Leadership, identifies utilization issues affecting the quality of patient care.
- Provides AHS physicians, nursing and staff education including InterQual® criteria methodology, resource management, medical necessity guidelines payer sources, clinical outcome metrics, length of stay initiatives, readmission strategies, reimbursement rules and medical record documentation requirements.
- Serves as Content Expert/Liaison to community agencies, AHS and Non AHS primary care provider network and all AHS stakeholders across all AHS facilities (i.e. Nursing and Hospital Administrators) for provision of care and services across the continuum of care.
- In conjunction with department managers and/or supervisors, coordinates, develops, and implements action plans to respond to areas felt to be in need of improvement related to patient flow and care coordination across the continuum.
- Assumes accountability for improving utilization metrics associated with department/unit and meeting organizational/departmental targets.
- Evaluates, plans, and executes changes in department procedures, equipment and supplies.
- Performs all other duties as assigned.
MINIMUM QUALIFICATIONS:
- Required Education: Master's degree in Nursing or Master's degree in Social Work or related field.
- Required Experience: Seven to ten years of case management or quality experience in addition to progressive management experience in a large healthcare organization is required.
- Preferred Experience: N/A
Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California or valid license as a Clinical Social Worker issued by the State of California Board of Behavior Science Examiners; active BLS - Basic Life Support Certification issued by the American Heart Association; CPI -Crisis Prevention Intervention Training; Other advanced life support certifications may be required per unit/department specialty according to patient care policies.
Preferred Licenses/Certifications: Certification in Case Management, CCMC or ACM.
Highland General Hospital
SYS Care Coordination
Full Time
Varies
Management
FTE: 1
-
Director, Inpatient System 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...
-
Director, Inpatient System Care Management
4 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...
-
Director, Inpatient System Care Management
2 weeks ago
Oakland, California, United States Highland General Hospital Full timeDirector of Inpatient System Care Management at Alameda Health SystemAlameda Health System offers amazing benefits for their employees, such as: 100% employer health plan coverage for employees and their eligible dependents Unique benefit options that are fully or partially covered by the employer Various retirement plans and the opportunity to participate...
-
Director, Inpatient System Care Management
1 month ago
Oakland, United States John George Psychiatric Pavilion Full timeAlameda 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: ...
-
Director, Inpatient System Care Management
4 weeks ago
Oakland, United States John George Psychiatric Pavilion Full timeAlameda 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: ...
-
Manager, Care Mgmt
3 weeks ago
Oakland, United States Altais Health Solutions Full time**About Our Company** At Altais, we're looking for bold and curious innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, patients, and the clinical community. At Altais, we’re building breakthrough clinical support tools, technology, and services to let doctors do what they...
-
Manager, Care Management
2 weeks ago
Oakland, California, United States Alameda Health System Full timeManager, Care Management+ Oakland, CA+ Highland General Hospital+ HGH Care Coordination+ Full Time - Day+ Management+ Req #:FTE:1+ Posted:December 23, 2023Summary*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...
-
Manager, Care Management
2 weeks ago
Oakland, United States Alameda Health System Full timeJob DescriptionSummaryAlameda Health System offers outstanding benefits that include:100% employer health plan for employees and their eligible dependentsUnique benefit offerings that are partially or 100% employer paidRich and varied retirement plans and the ability to participate in multiple plans.Generous paid time off plansRole Overview:Alameda Health...
-
Manager, Care Management
4 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...
-
Care Management Specialist
3 weeks ago
Oakland, United States Alameda Health System Full time**Summary** **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 &...
-
Manager, Care Management
1 week ago
Oakland, United States Alameda Health System Full timeJob DescriptionSummaryAlameda Health System offers great benefits to our employees! 100% employer health plan for employees and their eligible dependentsUnique benefit offerings that are partially or 100% employer paidRich and varied retirement plans and the ability to participate in multiple plans.Generous paid time off plansRole Overview:The Manager of...
-
Care Management Specialist
2 weeks ago
Oakland, 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...
-
Care Management Specialist
2 weeks ago
Oakland, United States Alameda Health System Full timeJob DescriptionSummarySUMMARY: 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...
-
Nurse Manager
4 weeks ago
Oakland, United States Staffeagle llc Full time**Job Title: Nurse Manager - Inpatient Pediatrics** **City: Oakland, CA** **Onsite** **What are the requirements of this position?** MUST HAVE CURRENT CA RN LICENSE BS, BSN, or higher degree 4 years in an inpatient acute care Pediatrics hospital unit **What are the nice-to-have skills?** Experience building teams and future workforce...
-
Nurse Manager, Palliative Care
4 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...
-
Nurse Manager, Palliative Care
2 weeks ago
Oakland, United States Alameda Health System Full timeJob DescriptionSummaryAlameda Health System offers outstanding benefits that include:100% employer health plan for employees and their eligible dependentsUnique benefit offerings that are partially or 100% employer paidRich and varied retirement plans and the ability to participate in multiple plans.Generous paid time off plans Role Overview:Alameda Health...
-
Executive Director
3 days ago
Oakland, United States Elder Care Alliance Full timeActual pay decision based on factors including experience, skills, and training. Do you enjoy working with seniors? Do you want to work in a setting where you are valued and appreciated? Mercy Retirement & Care Center is a vibrant retirement community located in Oakland, California. We provide senior assisted living, memory care, skilled nursing, and...
-
Director, Surgery
4 weeks ago
Oakland, United States UCSF Benioff Children's Hospital Oakland Full time**Job Description/Summary**: Reporting to the Executive Director of Perioperative services, the Director of Surgical Services is responsible for outlining the vision, strategic direction, and operational leadership to guide practice and processes in the perioperative area. This role has multi-site responsibilities including BCH Oakland Main Campus, BCH...
-
Director, Surgery
24 hours ago
Oakland, United States UCSF Benioff Children's Hospital Oakland Full time**Job Description/Summary**: Reporting to the Executive Director of Perioperative services, the Director of Surgical Services is responsible for outlining the vision, strategic direction, and operational leadership to guide practice and processes in the perioperative area. This role has multi-site responsibilities including BCH Oakland Main Campus, BCH...
-
Area Pharmacy Director
3 weeks ago
Oakland, United States Kaiser Permanente Full time**Job Summary**: Leads the planning, development and implementation of Area strategic initiatives in Pharmacy Operations. Areas of responsibility include quality, utilization, finance, day-to-day operations, service, and human resources for Pharmacy Operations. Integrates those activities with California pharmacy strategic initiatives and goals, as well as...
