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Care Management Director
2 months ago
Job Summary:
Alameda Health System is seeking a highly skilled Care Management Director to lead our care management team. As a key member of our leadership team, you will be responsible for developing and implementing care management policies, procedures, and practices that align with our hospital's mission and goals.
Key Responsibilities:
- Develop and implement care management policies, procedures, and practices that align with our hospital's mission and goals.
- Conduct regular staff meetings to inform staff of changes in policies and procedures.
- Conduct interdepartmental team conferences to identify aberrant utilization and develop strategies to address it.
- Develop and provide statistical UM information and reports to appropriate committees.
- Manage and coordinate data gathering and record keeping required by Federal and State agencies, the Joint Commission, and hospital policies.
- Coordinate and develop action plans to respond to areas felt to be in need of improvement related to patient flow and care coordination across the continuum.
- Manage day-to-day operations of utilization management, care coordination, and discharge planning activities.
- Oversee submission of audits, including but not limited to MediCal, Medicare, and internal compliance studies.
- Oversee the secondary review process and actively appeal denied cases when necessary.
- Perform daily clinical rounds and monthly audit of charts on care management activities.
- Prepare cost analysis reports and other data needed for the preparation of the departmental budget.
- Provide 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.
Requirements:
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; 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.
