Supervisor, Outpatient Case Management- San Diego
3 weeks ago
Job DescriptionThe Supervisor, Outpatient Case Management has accountability for the direct, daily supervision of case managers' and coordinators' work with members, documentation of interventions, and reporting of activities per established protocols. The CM Supervisor maintains visibility to the outpatient CM team and provides "real time" CM guidance and direction as appropriate.ResponsibilitiesOversees the process, management, and reporting of Outpatient Case Management activities with focus on health plan compliance and decreasing utilization.Works with the CM leadership to contribute to the development of CM processes and procedures as needed to ensure process compliance and improvementConducts internal audits of case management for Outpatient CM cases, provides feedback and coaching's to staff as neededMonitors and evaluates effectiveness of the case management plan and modifies as necessary to meet regulatory requirements to include all required elements. This includes coordinating services, evaluating treatments, intervening in crisis and provide general support. Hires, trains, coaches, and evaluates the performance of direct reports.Identify educational needs and provide training and educational resources for current and incoming staff.Responsible for achieving quality and productivity standards and for ensuring compliance with department policies and proceduresImproves on the effectiveness and efficiency of Outpatient CM staff, through process improvements activities. Provides leadership and supervision to case managers, and care coordinators.Participate in Health Network oversight activities, as assigned and requiredMaintain knowledge of current regulatory NCQA, CMS, and DMHC requirements and industry trendsAssists with submission deliverables for health plan auditsOversees internal department meetings (Interdisciplinary care team (ICT) meeting, team huddles, etc.) as applicable.Other projects and duties as assigned by department Manager and Director.Job Location: This position requires 20% Field Responsibilities within the San Diego area.QualificationsMinimum Education: Bachelor's Degree of Science in Nursing and other related fields or higher preferred.Minimum Experience: Two plus (2+) years of Case management or other similar programs experience in managed care required. Strong leadership skills with the ability to influence, manage, and motivate personnel. Must have analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. Ability to prioritize and multi-task. Able to work independently and make independent clinical and non-clinical decisions. Excellent communication skills. Maintain professional attitude when working with internal and external customers. Adeptly utilize computer programs - both Microsoft Office applications and job-specific electronic software applications. Maintain and ensure confidentiality of patient information. Three plus (3+) years demonstrated leadership and team management/development skills preferred. Experience in health plan audits and compliance is a plus.Req. Certification/Licensure: RN unrestricted active license required. Will consider LVN with supervisory experience in managed care. Knowledgeable in managed care, Medicare, Medicaid regulations, Model of Care and Case Management requirements.About UsWith approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.
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Orange, United States Prospect Medical Holdings Full timeThe Supervisor, Outpatient Case Management has accountability for the direct, daily supervision of case managers' and coordinators' work with members, documentation of interventions, and reporting of activities per established protocols. The CM Supervisor maintains visibility to the outpatient CM team and provides "real time" CM guidance and direction as...
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Supervisor, Outpatient Case Management
1 month ago
Orange, United States Prospect Medical Holdings Full timeThe Supervisor of Case Management is responsible for coordinating with physicians, staff, community resources and facilities regarding patient care. In conjunction with physicians, develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, identifies cost-effective protocols, and...
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Supervisor I, Case Manager
3 weeks ago
Orange, United States HealthRIGHT 360 Full timeHealthRIGHT 360 gives hope, builds health, and changes lives for people in need by providing comprehensive, integrated, compassionate care that includes primary medical care, mental health services, and substance use disorder treatment. Benefits and perks: HR360 offers a robust benefits package, including PTO, 15 paid holidays, commuter benefits, retirement...
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Supervisor I, Case Manager
3 weeks ago
Orange, United States HealthRIGHT 360 Full timeHealthRIGHT 360 gives hope, builds health, and changes lives for people in need by providing comprehensive, integrated, compassionate care that includes primary medical care, mental health services, and substance use disorder treatment. Benefits and perks: HR360 offers a robust benefits package, including PTO, 15 paid holidays, commuter benefits, retirement...
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Social Worker- San Diego
2 weeks ago
Orange, United States Prospect Medical Holdings Full timeJob Description In collaboration with the care team, the Social Worker is responsible for providing a range of social work services including psychosocial assessments, interventions, crisis intervention, short term case management, providing information and connecting resources for our patients and/or families to meet the needs of the members, family members...
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Social Worker- San Diego
2 days ago
Orange, United States Prospect Medical Holdings Full timeJob Description In collaboration with the care team, the Social Worker is responsible for providing a range of social work services including psychosocial assessments, interventions, crisis intervention, short term case management, providing information and connecting resources for our patients and/or families to meet the needs of the members, family members...
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Social Work Case Manager
1 month ago
Orange, United States Libertana Full timeJob DescriptionJob DescriptionJOB DESCRIPTIONPosition: CCA Case ManagerPay Range: $23-$27Reporting To: Lead Case Manager, Director of Waiver ServicesWork Type: RemotePOSITION SUMMARYThe Case Manager is responsible for the care coordination of clients for the ALWP clients under the Care Coordination Agency (CCA). Care coordination includes identifying,...
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Social Work Case Manager
1 day ago
Orange, United States Libertana Full timeJob DescriptionJob DescriptionJOB DESCRIPTIONPosition: CCA Case ManagerPay Range: $23-$27Reporting To: Lead Case Manager, Director of Waiver ServicesWork Type: RemotePOSITION SUMMARYThe Case Manager is responsible for the care coordination of clients for the ALWP clients under the Care Coordination Agency (CCA). Care coordination includes identifying,...
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Orange, United States Center for Human Development Full timeCase Manager- Outpatient Behavioral Health Services Orange, MA The Case Manager provides outreach and support to support incarcerated individuals who are engaged in the re-entry process to ensure they have the clinical and treatment supports necessary for success including medication assisted treatment, therapy, and other community services. Position...
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Orange, United States Center for Human Development Full timeCase Manager- Outpatient Behavioral Health Services Orange, MA The Case Manager provides outreach and support to support incarcerated individuals who are engaged in the re-entry process to ensure they have the clinical and treatment supports necessary for success including medication assisted treatment, therapy, and other community services. Position...
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CCT Transition Coordinator
3 weeks ago
Orange, United States Libertana Full timeJob Description Job Description JOB DESCRIPTIONPosition: CCT CoordinatorPay Range: $20-25Reporting To: CCA/CCT ManagerWork Type: RemotePOSITION SUMMARYThe CCT Coordinator is responsible for coordinating the options that are available to SNF residents. The CCT Coordinator is responsible for assisting in the liaison work between the State of California and the...
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High Intensity Case Manager
1 week ago
Orange, United States Alta Hospitals Full timeThe scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members medical, environmental and...
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CCT Transition Coordinator
3 weeks ago
Orange, United States Libertana Full timeJob Description Job Description JOB DESCRIPTION Position: CCT Coordinator Pay Range: $20-25 Reporting To: CCA/CCT Manager Work Type: Remote POSITION SUMMARY The CCT Coordinator is responsible for coordinating the options that are available to SNF residents. The CCT Coordinator is responsible for assisting in the liaison work between the State of California...
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Travel Nurse RN
1 week ago
Orange, United States Hiring Now Full timeAccess Healthcare is seeking a travel nurse RN Case Management for a travel nursing job in Orange, California. & RequirementsSpecialty:Case ManagementDiscipline:RNStart Date:06/10/2024Duration:13 weeks40 hours per weekShift:8 hours, daysEmployment Type:TravelAccess Healthcare Job ID #60038443. Pay package is based on 8 hour shifts and 40 hours per week...
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High Intensity Case Manager
3 weeks ago
Orange, United States Prospect Medical Holdings Full timeJob DescriptionThe scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members' medical, environmental...
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High Intensity Case Manager
1 week ago
Orange, United States Alta Hospitals Full timeThe scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members’ medical, environmental and...
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Case Manager Direct Support
3 weeks ago
Orange, United States Jespy House Full timeJob Purpose Under the supervision of the Residential/Community Based Supports Supervisor, the Case Manager serves individuals with learning, developmental and behavioral health disabilities through: direct support/case management; positive direction; and, advocacy in the community on behalf of and with the client. All are accomplished in accordance with...
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Case Manager Direct Support
2 days ago
Orange, United States Jespy House Full timeJob Purpose Under the supervision of the Residential/Community Based Supports Supervisor, the Case Manager serves individuals with learning, developmental and behavioral health disabilities through: direct support/case management; positive direction; and, advocacy in the community on behalf of and with the client. All are accomplished in accordance with...
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Community Health Worker
1 week ago
Orange, United States Alta Hospitals Full timeCommunity Health Worker: The CHW will work in the community in a variety of settings, including patient homes, medical offices, inpatient facilities (such as hospitals and EDs), community-based organizations, public facilities, homeless shelters, and more. The CHW will: advocate for patients; empower patients to become effective advocates for their own needs...
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Community Health Worker
3 weeks ago
Orange, United States Prospect Medical Holdings Full timeJob DescriptionCommunity Health Worker:The CHW will work in the community in a variety of settings, including patient homes, medical offices, inpatient facilities (such as hospitals and EDs), community-based organizations, public facilities, homeless shelters, and more. The CHW will: advocate for patients; empower patients to become effective advocates for...
