Case Management II Supervisor

4 weeks ago

Chula Vista, California, United States COMMUNITY HEALTH GROUP Full time
Job Summary

As a Case Management II Supervisor at Community Health Group, you will oversee the High Risk Case Management program, ensuring the optimal and timely delivery of proactive and collaborative case management and care coordination activities. You will supervise staff in day-to-day functions, including training and developing case management and care coordination staff to accomplish program goals and objectives. Additionally, you will assist in the development, maintenance, and implementation of metrics to appraise the productivity and quality of staff performance. You will also supervise the management and care coordination of identified high-risk members to reduce recurrent and unnecessary hospital admissions, readmissions, and emergency room visits. You will work closely with the Interdisciplinary Care Team and contracted physician groups to establish members' care needs. You will also supervise the process to promote smooth transitions of care for targeted members and coordinate individually needed interventions for select members based on CHG-established indicators. You will provide guidance to case managers and care coordinators with difficult cases and situations and assume responsibility for cases when risk management issues are identified. You will work with the Health Care Services management team to develop, implement, and evaluate interventions designed to enhance member outcomes, quality metrics, and increase customer satisfaction. You will also function as a resource to internal and external customers. Requirements

Education: Graduate from an accredited school of nursing or other clinical-related field required. BA degree in a health-related field preferred. Certification in case management preferred. Experience/Skills: 2 years' experience as a high-risk case manager and 1 year of experience in a managed care environment, hospital discharge planning, or outpatient clinic required. 1 year of supervisory experience preferred. Knowledge of population health, care/case management clinical operations, and management expertise relating to business planning, process improvement, budget administration, and personnel management. Working knowledge of Microsoft programs; proficiency with Word and Excel. Knowledge of managed care principles, CPT, ICD-10, HCPCS coding, experience with inpatient and outpatient medical review guidelines (MCG). Familiar with Medi-Cal, Medicare. Familiar with Web-based standard of care sites, i.e., NIH, ACOG. Ability to communicate effectively verbally and in writing; exceptional telephone and customer service skills; ability to establish effective working relationships with physicians and medical professionals. May be required to conduct in-person visits and assessments of members. Work Environment

Prolonged periods of sitting at a desk; intermittent standing, walking, and bending. May be necessary to work and attend meetings outside of the facility or normal business hours. Lifting 10 lb. or less. Driving within the County of San Diego. California driver's license in good standing. **Must have current authorization to work in the USA**

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