Senior Case Management Supervisor

18 hours ago

Chula Vista, California, United States Community Health Group Full time
Job Summary

Community Health Group is seeking a highly skilled and experienced Senior Case Management Supervisor to join our team. This role will be responsible for providing supervision to Clinical Case Managers in our High Risk Case Management program, ensuring the optimal and timely delivery of proactive and collaborative case management and care coordination activities.

Key Responsibilities
  • Supervise staff in day-to-day functions, including training and developing case management and care coordination staff to accomplish program goals and objectives.
  • Assist in the development, maintenance, and implementation of metrics to appraise the productivity and quality of staff performance.
  • Supervise the management and care coordination of identified high risk members to reduce recurrent and unnecessary hospital admissions, readmissions, and emergency room visits.
  • Work in close collaboration with Interdisciplinary Care Teams and contracted physician groups to establish members' care needs.
  • Supervise the process to promote smooth transitions of care for targeted members.
  • Coordinate individually needed interventions for select members based on CHG established indicators.
  • Provide guidance to case managers and care coordinators with difficult cases and situations; assume responsibility of cases when risk management issues are identified.
  • 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.
Requirements
  • Graduate from an accredited school of nursing or other clinical related field required.
  • BA degree in health related field preferred.
  • Certification in case management preferred.
  • 2 years' experience as a high risk case manager and 1-year 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.
Working Conditions

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

**Must have current authorization to work in the USA**

Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws.

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