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Care Management Operations Manager
2 months ago
The John George Psychiatric Pavilion is seeking a dedicated Manager of Care Management to oversee the daily operations related to utilization, discharge planning, and patient care coordination.
Key Responsibilities:
The Manager will play a crucial role in ensuring that care management policies and procedures align with regulatory standards and hospital protocols. Responsibilities include:
- Assisting the Director in the development and implementation of care management strategies.
- Conducting regular staff meetings to communicate updates on policies and procedures.
- Facilitating interdepartmental conferences to identify and address utilization discrepancies.
- Providing statistical data and reports to relevant committees to highlight utilization issues impacting patient care quality.
- Coordinating data collection and record-keeping as mandated by federal and state regulations.
- Collaborating with leadership to create and execute improvement plans for patient flow and care coordination.
- Managing the daily operations of utilization management and discharge planning.
- Overseeing pre-admission reviews and offering solutions for questionable admissions.
- Ensuring compliance with audits and managing appeals for denied cases.
- Maintaining low denial rates through effective utilization practices.
- Conducting clinical rounds and audits of care management activities.
- Preparing budget-related reports and analyses.
- Providing educational programs for staff and physicians.
- Managing recruitment, orientation, evaluation, and disciplinary actions for care management staff.
- Acting as a clinical consultant and guiding staff in assessments and care plans.
- Networking with external partners to stay informed about industry changes.
Qualifications:
Preferred Licenses/Certifications: Certification in Case Management (CCMC or ACM).
Preferred Education: Master's degree in Nursing, Social Work, or a related field.
Required Experience: A minimum of five years in clinical nursing or social work, with three years in case management and two years in a supervisory role.
Required Licenses/Certifications: Active Registered Nurse license in California or Clinical Social Work license in California, along with Basic Life Support Certification from the American Heart Association. Additional advanced life support certifications may be required based on department specialty.
Crisis Prevention Intervention Training is mandatory for all positions.
