Case Manager

Overview

• Lead the Case Management Department, ensuring compliance with healthcare regulations and standards.
• Collaborate with clinical and administrative leadership to meet service expectations and goals.
• Develop and implement strategic plans, business initiatives, and financial budgets for the department.
• Create a safe work environment fostering respect and positive morale among staff.
• Facilitate the Utilization Management Committee, ensuring effective agenda planning and data analysis.
• Oversee employee coaching, training, hiring, performance assessment, and payroll processes.
• Maintain records in compliance with legal and regulatory requirements, ensuring operational excellence.
• Demonstrate strategic and critical thinking to optimize resource utilization and performance improvement.

Key Responsibilities & Duties

• Plan, direct, and oversee daily operations of the Case Management Department.
• Ensure compliance with state and federal healthcare regulatory guidelines.
• Collaborate with Physician Advisors and Medical Directors to achieve department objectives.
• Facilitate Utilization Management Committee meetings, reviewing and analyzing data effectively.
• Identify strategies to improve resource utilization and service delivery workflows.
• Communicate effectively with staff, ensuring prompt information exchange and issue resolution.
• Hire, train, evaluate, and discipline employees as needed to maintain department standards.
• Monitor performance standards and implement continuous improvement initiatives.

Job Requirements

• Active licensure as a Registered Nurse or Clinical Social Worker in California.
• Bachelor of Science in Nursing (BSN) or equivalent degree required.
• Minimum two years of experience in acute care case management leadership.
• Four years of experience in acute care case management preferred.
• Knowledge of federal, state, and local regulatory standards.
• Strong organizational and time management skills with effective prioritization abilities.
• Certified Case Manager (CCM) or other relevant certifications preferred.
• Professional demeanor and excellent communication skills.