Providence Manager Case Management in San Pedro, California
Providence is calling a Manager Case Management (Full time/Day shift) to Providence Little Company of Mary Medical Center San Pedro San Pedro, CA.
We are seeking a Manager Case Management provide departmental direction for the functions of case management, utilization management, discharge planning, and denial management for all PMI HMO inpatient acute and skilled level care. Responsibilities include all aspects and activities responsible for monitoring the delivery of care to patients, the development of strategies to reduce costs and ensure the appropriate utilization of facilities and services and to provide appropriate discharge planning for every patient to return to their optimum level of function. Oversee the collection, analysis, and reporting of financial and quality data related to utilization management, quality improvement, and performance improvement. Plan, organize, analyze, develop and implement Departmental programs, services and strategies to ensure favorable Hospital operating results.
Adhere to all Budgetary and Productivity goals/standards. Ensure the attainment of Department and Hospital goals, policies and procedures. The Manager promotes interdisciplinary collaboration, fosters teamwork, and champions service excellence. Supervises all Inpatient Acute and SNF onsite and telephonic case managers in PMI UM. The UM Inpatient Case Management Manager works in collaboration with Discharge Planner Manager in UM Department to facilitate excellent communication, collaboration and safe transitions in care, post-acute follow up calls and documentation of all communication and physicians orders for post-acute care needs.
In this position you will:
Plan, direct, and supervise all aspects of the program, including advocating for critical HR needs necessary to meet strategic goals. Assure that the hospital is in compliance with JCAHO/CMS standards and other regulatory policies related to case management, discharge planning, and utilization management
Facilitate growth and development of the case management program consistent with the Providence Health Services philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed
Responsible for managing the day-to-day local-level operational budget and in conjunction with others for developing the operational and capital budgets. Has limited signature authority to authorize procurement of supplies Responsible for identifying and achieving optimal targeted financial outcomes via the inpatient case management process
Responsible for departmental personnel functions (ex: recruitment, onboarding and training, feedback and monitoring, corrective actions, etc.) in conjunction with supervisors and staff. Write and conduct annual and interim performance appraisal reviews for the professional and any applicable nonprofessional staff direct reports
Act as a liaison to facilitate communication and collaboration between all care partners (ex: physicians, hospitalists, nurse, community care managers, post-acute care facilities, and other community resources etc.)
Responsible for mentoring and leading a high-performance team of “systems thinkers” who incorporate leadership principles and vision in performing the functions of case management
Demonstrate initiative in identifying and pursuing opportunities for self-improvement and enhancement of professional competency and serves as a resource to the care management/case management team for self-improvement and enhancement of professional competency
Manage, promote, and maintain a competent, productive and quality staff. Focus of CME needs related to evidence-based practices in the area of discharge planning, case management, and utilization management. Use data to drive decisions, plan, and implement performance improvement strategies for case management
Responsible for overseeing the education of physicians, nurses, other associates, patients, and families related to the case management process
Will practice as a case manager a minimum of 40% of the time with focus on relief and overflow work as necessary to support all direct reports case management load and census of PMI UM admits across the spectrum
Required qualifications for this position include:
Bachelor's Degree in Nursing
Registered nurse with current license to practice professional nursing in the State of California
10 or more years multidisciplinary clinical experience including 4 years case management experience and 2 years management level experience
Experience in utilization management, case management, discharge planning, disease management and other cost/quality management program
Background in business planning and targeted clinical outcomes
Experience in change management
Thorough knowledge of health benefit and the administrative services performed in the processing of health benefit claims
Thorough understanding of the coding and classification systems used for medical records and medical services billing including the classification of disease and clinical procedural terminology
Knowledge of leading practice in clinical care and payer requirements
Working knowledge of managed care, inpatient, outpatient, and home health continuum, as well as utilization management and case management
Working knowledge of concepts and standards associated with performance improvement
Demonstrated effective working relationship with physicians
Demonstrated strategic planning skills
Ability to work collaboratively with health professionals at all levels to achieve established goals and improve quality outcomes
Personal Characteristics: Self-motivated, proven communication skills, assertive
Outstanding leadership skills
Outstanding communication skills with a reputation of keeping all stakeholders (leadership, associates, physicians, patients, and community partners) well informed
Goal oriented with the ability to maintain focus and move new initiatives forward in a collaborative, team based culture
Clear focus on results for quality, service, clinical excellence, and financial performance
Ability to motivate and mentor individuals to operate beyond their comfort zones
Knowledge and skill with MCG (Milliman) criteria and guidelines
Preferred qualifications for this position include:
Master's Degree or Masters program in progress
Certificate in Case Manager (CCM) or Accredited Case Manager (ACM)
About the hospital you will serve.
Providence Little Company of Mary Medical Center San Pedro is a 259-bed nonprofit hospital that has served the Harbor and greater South Bay communities since 1925. Our Medical Center offers a comprehensive array of medical and surgical services each distinguished by innovation, quality and excellence in its respective area. We received the CHART “Certificate of Excellence” for receiving superior or above average results across the majority of outcomes and process measures publicly reported by CHART. We ranked in the top 21 among more than 240 hospitals throughout the state compared by California Healthcare Foundation, and were the first location in the South Bay to carry the Gold Seal of Approval® from The Joint Commission for Primary Stroke Centers. As a member of Providence Health & Services, we are continually driven by the caring tradition of our heritage – the foundation of our Mission and core values – to embrace respect, compassion, justice, excellence and stewardship. Providence Health & Services today celebrates unprecedented growth, recognition for top quality health care, a vibrant employee culture where new ideas are encouraged and a drive to help the underprivileged - all with an eye toward the future.
For information on our comprehensive range of benefits, visit:
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Nurse Lead/Supervisor/Manager
Location: California-San Pedro
Req ID: 255613