Manager, Care Management - MMC

Sutter Health•Modesto, CA

About The Position

Manages the overall operations of the department for Sutter Health entities in accordance with current federal and state regulations and guidelines. Has frequent contact with the Administrative Team, Nurse Executives and Directors, Risk Management & Ethics staff, Ancillary Services, Revenue Cycle and Finance Department leaders, Medical Directors, Medical Staff leaders, physicians, contracted providers, community resources post-acute agencies, patients and their families.

Requirements

Bachelor's: BS in Nursing or Health Administration OR Master's: MS in Nursing, Case management, or related field; or Masters of Social Work for Social Work Candidates Only
RN-Registered Nurse of California Upon Hire OR LCSW-Licensed Clinical Social Worker Upon Hire
8 years recent relevant experience
Knowledge of ACMA, CMSA, and NASW Standards of Practice.
Knowledge of available health care and community resources
A broad knowledge base of health care delivery and case management within a managed care environment.
Comprehensive knowledge of laws, regulations and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS, Title 22, CHA Consent Manual, CDPH and TJC.
Verbal and written communication skills.
Group presentation design and facilitation skills.
Demonstrated ability to develop and manage complex projects.
Working knowledge of InterQual criteria.
Working knowledge of MIDAS and experience with an E.H.R. (EPIC preferred)
Ability to promote teamwork and to effectively function in teams, both as a leader and as a team member.
Ability to interact effectively with key internal and external constituents using collaboration, negotiation and analytical problem resolution skills.
Effective human relations and interpersonal skills necessary to lead the efforts of diverse health professionals to meet program objectives.
Ability to work effectively in a fast paced environment, directing services at multiple locations.
Analytical and mathematical skills.
Demonstrated ability to implement continuous quality improvement processes and techniques, including benchmarking and outcomes measurements.
PC skills, word processing, spreadsheets and managed care software programs.
Adheres to Sutter health policies and procedures and supports Sutter health philosophies and initiatives.
Strong problem resolution abilities and customer relation skills

Responsibilities

Manages the overall operations of the department for Sutter Health entities in accordance with current federal and state regulations and guidelines.
Participates as member of the utilization Management committee (UMC).