Manager, Care Management

4 weeks ago

Oakland, United States John George Psychiatric Pavilion Full time

John George Psychiatric Pavilion

Manager, Care Management

Oakland ,

California

Apply Now

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

#J-18808-Ljbffr

  • Manager, Care Management

    3 weeks ago

    Oakland, United States Alameda Health System Full time

    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...

  • Manager, Care Management

    2 months ago

    Oakland, United States Alameda Health System Full time

    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...

  • Manager, Care Management

    1 week ago

    Oakland, United States Alameda Health System Full time

    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...

  • Manager, Care Management

    5 days ago

    Oakland, United States The Ladders Full time

    About Our Company At Altais, we're looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. At Altais, we're building breakthrough clinical support tools, technology, and...

  • Manager, Care Management

    3 weeks ago

    Oakland, United States Altais Full time

    Job DescriptionJob DescriptionAbout Our CompanyAt Altais, we’re looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. At Altais, we’re building breakthrough clinical...

  • Manager, Care Management

    2 weeks ago

    Oakland, United States Altais Full time

    Job DescriptionJob DescriptionAbout Our CompanyAt Altais, we’re looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. At Altais, we’re building breakthrough clinical...

  • Manager, Care Management

    21 hours ago

    Oakland, United States Altais Full time

    Job DescriptionJob DescriptionAbout Our CompanyAt Altais, we’re looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. At Altais, we’re building breakthrough clinical...

  • Manager, Care Management

    1 week ago

    Oakland, United States Altais Full time

    Job DescriptionJob DescriptionAbout Our CompanyAt Altais, we’re looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. At Altais, we’re building breakthrough clinical...

  • Care Management Specialist

    3 weeks ago

    Oakland, United States John George Psychiatric Pavilion Full time

    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...

  • Care Management Specialist

    2 weeks ago

    Oakland, United States John George Psychiatric Pavilion Full time

    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...

  • Care Management Specialist

    4 days 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 &...

  • Care Management Specialist

    7 days ago

    Oakland, United States Highland General Hospital Full time

    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...

  • 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 & ESSENTIAL...

  • Manager, Spiritual Care

    2 weeks ago

    Oakland, United States Alameda Health System Full time

    Summary SUMMARY: The 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...

  • Care Manager, Lvn

    5 days 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. Doctors today are faced with the reality of spending more time on administrative tasks than caring for patients....

  • Program Manager/counselor

    22 hours ago

    Oakland, United States LifeLong Medical Care Full time

    Overview: LifeLong Medical Care is looking for a **Program Manager/Counselor** at our TRUST Health Center in Oakland. The Program Manager/Counselor will oversee all aspects of the SAMHSA MAT program. This is a full time, exempt, benefit eligible position.- Benefits_ - Compensation: $70k - $75k/year. We offer excellent benefits including: medical, dental,...

  • Case Manager Ii

    1 week ago

    Oakland, United States LifeLong Medical Care Full time

    Overview: The **Case Manager II** (CM II), a key member of the primary care interdisciplinary team, provides services for patients with complex care needs. This position conducts patient outreach, engagement and psychosocial service assessment, assists in developing a patient-centered care plan, is the lead implementer of Enhanced Case Management (ECM) and...

  • Area Gas Operations Manager II

    3 weeks ago

    Oakland, United States Waste Management Full time

    As an EEO/Affirmative Action Employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, or veteran status. Waste Management (WM), a Fortune 250 company, is the leading provider of comprehensive waste and environmental...

  • Lead Care Manager Alameda

    2 weeks ago

    Oakland, United States Titanium Healthcare Full time

    **Lead Care Manager Job Summary**: The Lead Care Manager (LCM) is responsible for case management of members and their families in obtaining and understanding services and programs available through the Enhanced Care Management (ECM) program. The Lead Care Manager is tasked with improving their health and overall well-being through our services. The Lead...

  • Nurse Manager, Palliative Care

    1 month ago

    Oakland, United States Alameda Health System Full time

    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...