Manager, Care Management

2 weeks ago

Oakland, United States Alameda Health Sytem Full time

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 Care Management at Highland is responsible for the day-to-day operations of facility wide utilization, discharge planning and care coordination. 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 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 be in need of 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 payers 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. Review 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 Not the right fit? Join our Talent Network to opt-in to all our current and future opportunities

#J-18808-Ljbffr

  • Manager, Care Management

    2 weeks ago

    Oakland, United States Alameda Health System Full time

    Summary 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

    2 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

    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...

  • 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

    1 month ago

    Oakland, United States Alameda Health System Full time

    Summary 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, 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...

  • Manager, Spiritual Care

    1 month 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...

  • Nurse Manager, Palliative Care

    4 days 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...

  • RN Medical Care Manager

    3 weeks ago

    Oakland Park, United States AIDS Healthcare Foundation Full time

    RN Medical Care ManagerWHO WE ARE AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation! Does the idea of doing something that really makes a difference in people's lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its...

  • Nurse Manager, Palliative Care

    2 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...

  • 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...

  • RN Medical Care Manager

    1 month ago

    Oakland Park, FL, United States AIDS Healthcare Foundation Full time

    RN Medical Care Manager AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation! If so, AIDS Healthcare Foundation is the place for you! Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of...

  • RN Medical Care Manager

    3 weeks ago

    Oakland Park, FL, United States AIDS Healthcare Foundation Full time

    RN Medical Care Manager WHO WE ARE AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation! Does the idea of doing something that really makes a difference in people's lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its...

  • Emergency Management Specialist

    5 days ago

    Oakland, California, United States Federal Emergency Management Agency Full time

    What will I do in this position if hired?In this Emergency Management Specialist (Recovery) position, typical assignments include:Coordinating with applicants throughout all phases of the disaster recovery process to provide advice, guidance and technical assistance on laws, policies and regulations. Researching details of large Public Assistance grant...

  • Logistics Management Specialist

    3 weeks ago

    Oakland, United States Federal Emergency Management Agency Full time

    Summary The ideal candidate should possess the ability to lead, communicate, manage and build partnerships within FEMA and across multiple federal, state, territorial, tribal, and non-governmental agencies while operating in a high-stress environment and austere conditions. Duties What will I do in this position if hired? In this Logistics...

  • Care Management Community Health Worker

    3 days ago

    Oakland, United States Alameda Health System Full time

    Summary SUMMARY: Provides care coordination and advocacy to patients, including outreach and engagement, development of the care plan, linkage of the patient with resources (food, housing, transport, financial, community based services) as well as linking the patient with care. DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties...

  • Emergency Management Specialist

    4 days ago

    Oakland, United States Federal Emergency Management Agency Full time

    What will I do in this position if hired? In this Emergency Management Specialist (Recovery) position, typical assignments include: Coordinating with applicants throughout all phases of the disaster recovery process to provide advice, guidance and technical assistance on laws, policies and regulations. Researching details of large Public Assistance...

  • INPATIENT PEDIATRIC NURSE MANAGER

    4 weeks ago

    Oakland, CA, USA, United States Clinical Management Consultants Full time

    A new opportunity has just become available for an Inpatient Pediatric Nurse Manager with a reputable hospital in the beautiful sunshine state of California! This Inpatient Pediatric Nurse Manager opening is with a 350 patient bed medical center that Nurse Manager, Manager, Pediatric, Patient, Nurse, Patient Care, Healthcare, Staffing

  • Logistics Management Specialist

    3 weeks ago

    Oakland, United States Federal Emergency Management Agency Full time

    Summary In this position you will serve as a Logistics Management Specialist, the Department of Homeland Security, Federal Emergency Management Agency, Regional Offices, Regional 9, Response Division. The ideal candidate for this position will be familiar with writing and executing Logistics plans with an emphasis on contingency planning, a working...

  • Care Management Community Health Worker

    4 days ago

    Oakland, United States Alameda Health System Full time

    **Summary** **SUMMARY**:Provides care coordination and advocacy to patients, including outreach and engagement, development of the care plan, linkage of the patient with resources (food, housing, transport, financial, community based services) as well as linking the patient with care. **DUTIES & ESSENTIAL JOB FUNCTIONS**: NOTE: The following are the duties...