Manager, Care Management
Company: Alameda Health System
Location: Oakland
Posted on: November 15, 2024
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Job Description:
Summary
Alameda Health System offers outstanding benefits that include:
Role Overview:
Alameda Health System is hiring! The Manager of Care Management is
responsible for the day-to-day operations of facility wide
utilization, discharge planning and care coordination.
DUTIES & ESSENTIAL JOB FUNCTIONS: -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 everyone in the
classification.
-Assists 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 policies.
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-Conducts and records periodic staff meetings, to inform staff of
changes in policies and procedures.
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-Conducts interdepartmental team conferences for identifying
aberrant utilization; establishes a method of tracking variances
based on critical timelines.
-Develops 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 care.
-Direct 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 projects.
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-In conjunction with VP and Director, coordinates, develops, and
implements action plans to respond to areas felt to need
improvement related to patient flow and care coordination across
the continuum.
-Manages and assumes responsibility for day-to-day operations of
utilization management, care coordination and discharge planning
activities.
-Manages process of pre-admission review of questionable admissions
as referred by Admitting, Emergency Room and medical staff and
offers workable solutions.
-Oversees submission of any audits, including but not limited to
MediCal, Medicare and internal compliance studies.
-Oversees the secondary review process; actively appeals denied
cases when necessary and assists physicians with appeals. Maintains
minimal denial rates by Medicare, MediCal, private and contracted
payors through appropriate direction of utilization practices;
assists physicians and hospital personnel in understanding care
management issues.
-Perform all other duties as assigned.
-Performs daily clinical rounds and monthly audit of charts on care
management activities (utilization review, discharge planning and
Interrater Reliability).
-Prepares cost analysis reports and other data needed for the
preparation of the departmental budget.
-Provides in house educational programs as needed for both staff
and physicians.
-Responsible for the recruitment, orientation, evaluation,
counseling and disciplinary action of care management clinical and
administrative staff.
-Responsible to purchase, educate, and record education to new
equipment and/or techniques.
-Reviews 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
documentation.
-Serves 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 profession.
-Supervises technical procedures and performs procedures as
needed.
MINIMUM QUALIFICATIONS:
Preferred Licenses/Certifications: Certification in Case
Management, CCMC or ACM.
Preferred Education: Master's in Nursing or Masters in Social Work
or related field.
Required 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 experience in 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 Training (required for all positions at
John George Psychiatric Pavilion; and certain positions in the
Emergency Department
Highland General Hospital
HGH Care Coordination
Full Time
Day
Management
FTE: 1
Keywords: Alameda Health System, Oakland , Manager, Care Management, Executive , Oakland, California
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