Manager, Outpatient Case Management

Regal Medical Group • Los Angeles, CA

93d • $110,000 - $125,000

About The Position

The Manager of Outpatient Case Management is responsible for management and oversight of Regal Outpatient Care Management Programs. The Program and Department coordinate and manage care of enrollees designated at high risk for progression of disease, clinical decline, and in need of urgent or emergent care. Directly responsible for daily operations of the Program and Department and for operational partnership with concurrent review team managing inpatient and SNF admissions, home health care services, home visit program staff, hospice agencies, and preauthorization department. Cooperation and problem solving with Network Management, Finance, and Claims is also expected. Responsible for processes to oversee ambulatory case management including standardized documentation and auditing, programs that maximize quality, programs to ensure appropriate resource utilization within members benefit plan and established contracts. The Manager is responsible to work in collaboration with other Medical Management Departments to ensure optimal clinical outcomes, appropriate resource utilization, quality patient care, and high enrollee satisfaction.

Requirements

• Previous management experience required.
• Must have experience in managing high risk cases.
• High level knowledge of Case Management processes and principles.
• Prior experience in MSO environment preferred.
• Ability to work with all levels of management.
• Must have excellent verbal and written communications skills.
• Must have excellent organizational skills.
• Must have prior experience with project development and implementation.
• Must have working knowledge of MS Office environment.
• Requires active CA RN license, CCM certification preferred.

Responsibilities

• Manages and monitors Enrollees assigned to Outpatient Case Management programs to ensure efficient and timely delivery of care, timely referrals, and moving the Enrollee’s treatment plans through the care continuum.
• Develops, monitors, and analyzes Program and Department reports and identifies trends to improve clinical and utilization and quality outcomes.
• Collaborates with the RMG Medical Directors to analyze data and implement programs that will improve Enrollee outcomes.
• Develop a standardized process for triaging and enrollment of appropriate members into Outpatient Case Management programs for RMG North.
• Identifies and develops Program and Department policies and procedures and ensures compliance and consistency throughout RMG regional sites.
• Develops and coordinates Program and Department strategies for ensuring the delivery of care in the most cost effective setting.
• Act as a resource for hospitalists, SNFs, outpatient utilization management staff, home health care agencies, Employer home-visit physicians and nurse practitioners.
• Motivates, instructs, mentors, audits and leads and constantly improves the quality of service and clinical outcomes rendered by the Employer’s Outpatient Case Management staff.
• Develops annual Program and Department goals and objectives focused on improving patient outcomes and efficiency.
• Implements tools and processes that direct and role model a high level of customer service behavior toward Enrollees.
• Works collaboratively with the entire Medical Management team to ensure that Employer company goals as well as compliance with regulatory and health plan requirements are met.
• Has direct oversight responsibility and accountability of the Program and Department case management and ancillary staff in RMG North.
• Training, mentoring, auditing of the clinical competency, productivity, contribution, customer service interaction of Program and Department professional and non professional staff.
• Provide regular audit reports on Program and Department staff and action plans to improve efficiency and efficacy.
• Manager’s service area jurisdiction and responsibilities may be expanded and/or changed at Employer’s discretion and in consultation with the Vice President of Clinical Operations.
• Other responsibilities to be determined by mutual agreement in consultation with the Vice President of Clinical Operations.

Benefits

• Employer-paid comprehensive medical, pharmacy, and dental for employees.
• Vision insurance.
• Zero co-payments for employed physician office visits.
• Flexible Spending Account (FSA).
• Employer-Paid Life Insurance.
• Employee Assistance Program (EAP).
• Behavioral Health Services.
• 401k Retirement Savings Plan.
• Income Protection Insurance.
• Vacation Time.
• Company celebrations.
• Employee Referral Bonus.
• Tuition Reimbursement.
• License Renewal CEU Cost Reimbursement Program.
• Business-casual working environment.
• Sick days.
• Paid holidays.
• Mileage.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees