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Alameda Health System: Slh Manager, Care Management

Alameda Health System

This is a Full-time position in Moraga, CA posted October 12, 2021.

JOB SUMMARY: San Leandro hospital is seeking a highly skilled Manager of Care Management.

We are seeking an RN with experience in Care Management.

This Manager will need to have experience within hospital case management that is recent.

In this role you will be responsible for direct report management and overseeing the day to day operations.DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification; however, employees may perform other related duties at an equivalent level.

Not all duties listed are necessarily performed by each individual in the classification.Manages and assumes responsibility for day to day operations of utilization management, care coordination and discharge planning activitiesResponsible for the recruitment, orientation, evaluation, counseling and disciplinary action of care management clinical and administrative staffReviews cases regularly with staff; acts as clinical consultant regarding care management issues; guides clinical staff with review of assessments and care plans, evaluates utilization reviews or documentationServes as a content expert to staff and internal departments and external partners; networks with other hospitals, nursing organizations, and professional organizations to keep abreast of changes within the professionOversees submission of any audits, including but not limited to MediCal, Medicare and internal compliance studiesPerforms daily clinical rounds and monthly audit of charts on care management activities (utilization review, discharge planning and Interpreter ReliabilityConducts interdepartmental team conferences for identifying aberrant utilization; establishes a method oftracking variances based on critical timelinesAssists Director in establishing, implementing and ensuring that care management policies, practices and procedures are in accordance with the Joint Commission, Title 22 and other regulatory agencies and overall hospital policiesDirect and coordinate data gathering and record keeping legally required by Federal and State agencies, the Joint Commission, and hospital policies; participates in the risk mitigation, process of implementing new or revised processes, and projectsManages process of pre-admission review of questionable admissions as referred by Admitting, Emergency Room and medical staff and offers workable solutions.

Oversees the secondary review process; actively appeals deniedcases when necessary and assists physicians with appeals.

Maintains minimal denial rates by Medicare, MediCal, private and contracted payers through appropriate direction of utilization practices; assists physicians and hospital personnel in understanding care management issuesProvides in house educational programs as needed for both staff and physiciansDevelops and provides statistical UM information and reports to appropriate committees and in conjunction with the Director of Care Management identifies utilization issues affecting the quality of patient careIn conjunction with VP and Director, coordinates, develops, and implements action plans to respond to areas felt to be in need of improvement related to patient flow and care coordination across the continuumPrepares cost analysis reports and other data needed for the preparation of the departmental budgetResponsible to purchase, educate, and record education to new equipment and/or techniquesConducts and records periodic staff meetings, to inform staff of changes in policies and proceduresSupervises technical procedures and performs procedures as neededPerform all other duties as assigned MINIMUM QUALIFICATIONS:Preferred Education: Master’s in Nursing or Master’s in Social Work or Social WelfareRequired Experience: Five years of clinical nursing or social work experience in a directly related setting (e.G., acute care, skilled nursing, etc.); three years of case management experience; two years of experiencein a supervisory or lead role.Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California or licensed in Clinical Social Work in California, Active BLS Basic Life Support Certification issued by the American Heart Association.

Other advanced life support certifications may be required per unit/department specialty according to patient care policies.

CPI Crisis Prevention Intervention TrainingPreferred Licenses/Certifications: Certification in Case Management, CCMC or ACMSan Leandro HospitalSLH Social ServicesFull TimeDayManagementFTE: 1