Director Case Management - Full Time, Days (Culver City)

Prospect Medical Holdings•Culver City, CA

30d•Onsite

About The Position

The Director of Case Management (DCM) is accountable for planning, directing and overseeing all aspects of daily operations of the Case Management Department. Ensures standards of operations are in accordance with all state and federal healthcare regulatory guidelines. Works closely with Physician Advisors and Medical Directors assigned to the Facility(s). Facilitates the Utilization Management Committee. Responsible for employee coaching, training, hiring, counseling/discipline, performance assessment and payroll processes. Completes reports and analyzes data as assigned. Develops and implements strategic plans, unit/department goals and objectives, business initiatives, and financial plans and budgets. Complies with all policies/procedures, applicable laws and regulatory agency requirements, and organization work standards. Assumes responsibility for decisions made. Maintains records in compliance with legal and regulatory requirements. Demonstrates strategic and critical thinking; makes optimal use of resources; allocates and prioritizes work monitoring performance standards for continuous performance improvement. Facilitates Utilization Management Committee. Responsible for planning subject matter and agenda. Appropriately reviews, revises, and analyzes data prior to meeting. Ensures that avoidable and variance days are addressed, an action plan is put in place, and goals are set, communicated, and met. Reviews and distributes minutes to members of UM Committee. Collaborates effectively with clinical and administrative leadership, physicians, nurses and a wide variety of other staff to ensure that service expectations and length of stay goals are met. Identifies strategies to improve resource utilization, service delivery, work flow, etc. as necessary to meet established expectations. Ensures prompt and proper information exchanges and issue resolution. Appropriately informs Vice President of Case Management of issues needing immediate attention. Creates a safe work environment that fosters respect and positive morale. Effectively allocates and evaluates department work, and provides leadership and appropriate follow through to the Department. Effectively communicates with all staff. Responsible for hiring, firing, training, annual performance evaluations and competencies, and disciplinary process.

Requirements

Active, current, and unencumbered Licensure as a Registered Nurse or Clinical Social Worker in the State of California OR Master's Degree in Business, Health Care Administration or other related field
Four (4) years of experience in an Acute Care Case Management role
Minimum 2 years of experience in Acute Care Case Management leadership role
Excellent verbal and written communication skills
Computer literate
Knowledge of all Federal, State and Local regulatory standards
Professional demeanor with Healthcare team
Strong Organizational and Time Management skills with ability to effectively prioritize tasks
Demonstrated Leadership Skills

Nice To Haves

Bachelors or Masters of Science in Nursing
InterQual or MCG criteria knowledge
Certified Case Manager (CCM) or other Case Management/Nursing Certification

Responsibilities

Planning, directing and overseeing all aspects of daily operations of the Case Management Department
Ensuring standards of operations are in accordance with all state and federal healthcare regulatory guidelines
Working closely with Physician Advisors and Medical Directors assigned to the Facility(s)
Facilitating the Utilization Management Committee
Employee coaching, training, hiring, counseling/discipline, performance assessment and payroll processes
Completing reports and analyzes data as assigned
Developing and implementing strategic plans, unit/department goals and objectives, business initiatives, and financial plans and budgets
Complying with all policies/procedures, applicable laws and regulatory agency requirements, and organization work standards
Assuming responsibility for decisions made
Maintaining records in compliance with legal and regulatory requirements
Demonstrating strategic and critical thinking; makes optimal use of resources; allocates and prioritizes work monitoring performance standards for continuous performance improvement
Planning subject matter and agenda for Utilization Management Committee
Reviewing, revising, and analyzing data prior to meeting
Ensuring that avoidable and variance days are addressed, an action plan is put in place, and goals are set, communicated, and met
Reviewing and distributing minutes to members of UM Committee
Collaborating effectively with clinical and administrative leadership, physicians, nurses and a wide variety of other staff to ensure that service expectations and length of stay goals are met
Identifying strategies to improve resource utilization, service delivery, work flow, etc. as necessary to meet established expectations
Ensuring prompt and proper information exchanges and issue resolution
Informing Vice President of Case Management of issues needing immediate attention
Creating a safe work environment that fosters respect and positive morale
Effectively allocating and evaluating department work, and provides leadership and appropriate follow through to the Department
Effectively communicating with all staff
Responsible for hiring, firing, training, annual performance evaluations and competencies, and disciplinary process