Case Management - Medical RN at Ultimate Staffing Services in Los Alamitos, California

Job Description:

Position Summary


Reporting to the Senior Vice President of Clinical Operations for operational matters and the Client Medical Director for clinical concerns, the Case Management Manager plays a pivotal role in the company's success. This position oversees the development and continuous management of all case management programs within the organization. The manager is responsible for establishing guiding principles, implementing interventions, and formulating strategies aimed at promoting client stability, wellness, and independence. This is achieved through a comprehensive approach that includes advocacy, assessment, planning, communication, education, resource management, care coordination, collaboration, and service facilitation.


RESPONSIBILITIES AND DUTIES


Review inpatient cases and provide guidance to inpatient case managers for reviews, hospital transfers, observation, discharge planning, and transitions of care.?


Review outpatient cases and provide guidance to outpatient case managers for reviews, case management program overview, and adherence to processes for disease management, complex case management, and the management of DSNP.?


Inspire the team to develop creative strategies to prevent hospital admissions and ensure patients receive the highest quality of care at home or in a care facility. Lead Monday nurse team meetings.?


Identify, develop, and oversee the educational needs of the team, motivating and leading them in setting and achieving improvement goals.?
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Collaborate with the team to enhance the systems utilized in case management.?


Participate in projects for platform development related to case management.?


Recruit and retain case management team members.?


Conduct annual performance appraisals.?


Provide coaching and disciplinary actions as necessary.?


Participate in budget preparation as needed.?


Analyze staffing ratios and productivity levels.?


EDUCATION AND EXPERIENCE REQUIREMENTS


Demonstrate deep compassion for patients and the care they receive.?


Valid California RN license.?


Bachelor's degree required; master's degree in nursing or a health-related major preferred.?


CCM certification desirable.?
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Minimum of 5 years of utilization management and case management experience in an IPA/PMG or HMO setting.?
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Experience in management, including hiring, counseling, and terminations.?


Maintain confidentiality and adhere to HIPAA policies.?


Possess managerial skills necessary to independently manage both on-site and remote teams.?


Exhibit competent leadership and effective communication skills (verbal and written) with the proven ability to positively influence behavior and achieve "win-win" resolutions when possible.?


Strong clinical judgment necessary to interpret and follow medical guidelines.?


Demonstrated ability to resolve complex issues.?


Be courteous and promote professionalism.?


Be flexible and adaptable.?


Promote organizational goals.?


Know and follow safety standards.?


Possess analytical skills to review and interpret metrics.


All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county , to the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.