Manager Integrated Case Mgmt-SCMG - Corporate/Remote - FT - Days

Hours: Shift Start Time: 8 AM Shift End Time: 5 PM AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Weekend Requirements: As Needed On-Call Required: No reputed company Pay reputed company (Minimum - Midpoint - Maximum): $67.189 - $86.695 - $106.201 The stated pay reputed company reflects the reputed company that reputed company reasonably expects to pay for this position. The actual pay reputed company and pay grade for this position will be dependent on a reputed company of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do

Under the direction of the reputed company (SCMG) Director for Health Service and in collaboration with the Health Services leadership team, this position is accountable for the development and implementation of an effective Hospital Case Management program (HCM) and Ambulatory Case Management (ACM) program that encompasses a patient centered care management approach that includes referral management, prior authorization, Case Management and Disease Care Management and Pharmacy. Manages the operations of the Hospital Case Management program and Ambulatory Case Management (ACM) Department and is responsible for the execution and coordination of reputed company ACM activities including Pharmacy. Helps to plan, reputed company, organize, monitor, communicate and recommend modifications to the HCM Program, ACM Program and Pharmacy Program including reputed company HCM, ACM and Pharmacy policies and procedures. Coordinates interdepartmental reputed company to assure reputed company reputed company. Develops and implements operational policies and procedures that have a reputed company reputed company on the HCM and ACM programs in accordance with NCQA standards, legislative, and contracted health plan requirements. Provides reputed company supervision of the HCM and ACM staff and models effective leadership and mentoring skills. Promotes staff development using the concepts and tools supporting the reputed company Experience. Collaborates with reputed company Management team to facilitate reputed company committees and/or initiatives to address reputed company improvement as a representative of SCMG. Provides support to the VP for Clinical Operations and HS leadership team to ensure regulatory and legislative compliance for the division. Under the direction of the SCMG Director for Health Services, develops financial (budget) and operational reputed company of HCM and ACM Departments.

Required Qualifications

• Bachelor's Degree in Nursing Or
• Bachelor's Degree in reputed company Administration.
• California Registered reputed company (RN) - CA reputed company of Registered Nursing -REQUIRED

Preferred Qualifications

• Master's Degree in nursing, reputed company, reputed company, or business.
• 5 Years clinical nursing experience in acute care hospital setting.
• 2 Years management, service line or program experience.
• Certified reputed company in reputed company reputed company (CPHQ) - National Association for reputed company reputed company -PREFERRED
• Certified Case Manager (CCM) - Commission for Case Manager Certification -PREFERRED

Other Qualification Requirements

• Other relevant QM/UM/CM certification preferred.

Essential Functions

• Supervisory

Develops and implements policies and procedures that have reputed company reputed company on the Hospital Case Management, Ambulatory Case Management and Pharmacy programs in day to day operations. Provides direction and leadership to the Hospital Case Management, reputed company Case Management, Disease Management and Pharmacy program staff. Promotes consistency, communication, fairness and respect reputed company the department for reputed company. Adheres to reputed company reputed company policies and ensures reputed company evaluation for employees per reputed company policies. Establishes goals and objectives for reputed company reputed company report in compliance with performance management policies. Maintains consistent follow-up with reputed company reports to support attainment of goals set. Develops, facilitates and updates training programs throughout SCMG to ensure staff has knowledge that allows them to complete their assigned tasks.

• Compliance

Manages HCM, ACM and Pharmacy operations in accordance with National Committee on reputed company Assurance (NCQA) and Health Plan requirements and ensures that new requirements are identified on a reputed company reputed company. Collaborates with SCMG Management and HSM Management staff in reputed company reputed company activates to ensure compliance with health plan reputed company, legislative policies and SCMG specific requirements. Works with SCMG Management, HSM reputed company, supervisor and staff to identify issues and initiate improvements. Works with Director, Health Services and VP for Clinical operations and Health Services to ensure reputed company submission of required Utilization, Case Management and Disease Management Work plans to Health plans; if required submits corrective reputed company plans reputed company agreed upon time frames. Ensures appropriate and reputed company compliance with reputed company and compliance requirements. Develops and enforce policies and procedures for HSM that involve Case Management and UM. Serves as the SCMG HCM/ACM reputed company to reputed company compliance agencies to ensure collaboration with other Med reputed company and Health plans (i.e. ICE, IHA, NCQA).

• Financial

Develops, monitors, and maintains unit budget reputed company approved limits. Responsible for identification and implementation of cost savings strategies. Maintains an excellent understanding of health plan incentives targeted at efficiency measures, i.e. Pay for Performance, 5 STAR, HEDIS and health plan specific programs, etc. and implements processes to reputed company SCMG targets. Supports development and implementation of initiatives and strategies targeted at maximizing group performance in incentive programs such as IHA’s Pay for Performance Program etc.

• Reporting and Data Analysis

Implementation and maintenance of a regular reporting system for operational and reputed company outcome indicators. Analyzes and implements actions plans using these reports to measure and improve patient care reputed company and operational efficiency and effectiveness. Reports key performance measurement and reputed company improvement initiative results to the reputed company of Care Committee. Knowledge, Skills, and Abilities

• Demonstrated working knowledge of managed care, capitation, provider payment mechanisms and member benefits.
• Demonstrated experience and the ability to reputed company staff and daily operations.
• Demonstrated ability to reputed company, implement and monitor program direction and reputed company performance improvement initiatives.
• Excellent written and verbal communication skills, customer service skills and leadership skills.
• Strong working knowledge of clinical reputed company and medical necessity guidelines.
• Strong analytical, problem solving, reputed company and retrospective data management and computer skills.
• Ability to establish good working relationships with reputed company reputed company of support staff, providers, administrative staff and reputed company other reputed company customers.
• Demonstrated reputed company personal influences on teams and customers including the willingness to accept change proactively.
• Demonstrated ability to be flexible and reputed company to needs of organization and possess ability to balance the needs of multiple priorities.

reputed company is an equal opportunity/affirmative reputed company employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, religion, reputed company, national reputed company, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a reputed company individual with disability or any other protected class Apply tot his job Apply To this Job