10.1 miles South from Mountain View (Only QUALIFIED Healthcare Professionals accepted) Case Manager-RN - Coordination of Care Services Director
San Francisco | Oakland | Fremont, California
JO# 25012
Come and join our team at our 200+ bed facility in beautiful California. Texas offers a tremendous quality of life with a wonderful climate, low cost of living, NO State Income Tax, and is a great place to call home!!
General Summary:The Director of Case Management leads and manages the day-to-day operations of utilization, clinical resource and case management departments and focuses on the continuum of care for the patient population.
Develops case management programs that allow the hospital(s) to meet clinical resource management goals as well as third party and regulatory standards.
Manages and educates staff at all levels about effective clinical resource management. Provides formal and informal programs.
Maintains effective working relationships and effectively communicates the goals and objectives of the program to the medical staff, department staff, and others within and outside the hospital.
Evaluates the effectiveness of existing clinical protocols and pathways and makes recommendations for new ones.
Promotes organizational mission statement and goals and empowers staff and peers to achieve outstanding performance.
Effectively reports departmental activities, goals, and measures of success.
Works effectively with MCO staff and leadership to decrease denials or downgrades in reimbursement.
Maintains department standards for regulatory and accreditation purposes.
Actively seeks to resolve those issues brought forward by medical staff that have an adverse effect on patient outcomes.
Analyzes the issues for cost/benefit in terms of improving clinical and financial outcomes.
Prioritizes and recommends effective approaches that will improve clinical and financial outcomes in the hospital.
Serves as the primary liaison between Case Management and the hospital Quality Committee.
Recommends plans of care for high profile DRGs that incorporate effective Case Management strategies.
Experience:5+ years experience in a health care facilityAt least 2+ years Nursing Management experience in an acute care setting requiredHospital Case Management experience requiredManaged Care Organization (MCO) experience preferred Education:Master's Degree in Nursing or a related healthcare field required
Certifications|Licensures:Registered Nurse License requiredCertified Case Manager (CCM) a plus, not requiredHealthcare Quality of Utilization Review (HQUR) a plus, not required Special Skills:Advanced communication and interpersonal skillsAnalytical and quantitative analysis skillsAbility to lead a complex department to reach and exceed goalsAbility to work with other departmentsKnowledge of Managed care trends, Medicare and Medicaid regulations
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