Manager, Care Management
Company: Alameda Health Sytem
Posted on: January 27, 2023
Alameda Health System offers great benefits to our employees!
- 100% employer health plan for employees and their eligible
- Unique benefit offerings that are partially or 100% employer
- Rich and varied retirement plans and the ability to participate
in multiple plans.
- Generous paid time off plans Role Overview: The Manager of Care
Management at Highland is responsible for the day-to-day operations
of facility wide utilization, discharge planning and care
coordination. 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 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.
- Conducts and records periodic staff meetings, to inform staff
of changes in policies and procedures.
- 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
- 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.
- In 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
- Manages and assumes responsibility for day to day operations of
utilization management, care coordination and discharge planning
- 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
payers through appropriate direction of utilization practices;
assists physicians and hospital personnel in understanding care
- 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
- Responsible for the recruitment, orientation, evaluation,
counseling and disciplinary action of care management clinical and
- Responsible to purchase, educate, and record education to new
equipment and/or techniques.
- Review 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
- 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
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Keywords: Alameda Health Sytem, Oakland , Manager, Care Management, Executive , Oakland, California
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