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Alameda Health Sytem
Oakland, CA, United States
Alameda Health System offers great benefits to our employees! 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer paid Rich and varied retirement plans and the ability to participate in multiple plans. Generous paid time off plans Role Overview: The M
Job Source: Alameda Health SytemAlameda Health System
Oakland, CA, United States
Alameda Health System Manager, Care Management Oakland , California Apply Now Alameda Health System offers outstanding benefits that include: 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer paid Rich and varied retirement plans and the ability to par
Job Source: Alameda Health SystemJohn George Psychiatric Pavilion
Oakland, CA, United States
John George Psychiatric Pavilion Manager, Care Management Oakland , California Apply Now Alameda Health System offers outstanding benefits that include: 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer paid Rich and varied retirement plans and the abil
Job Source: John George Psychiatric PavilionAltais
Oakland, CA, United States
Job Description Job Description About Our Company At Altais, we're looking for bold and curious innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, patients, and the clinical community. At Altais, we’re building breakthrough clinical support tools, technolog
Job Source: AltaisAcadia Healthcare
San Rafael, CA, United States
ESSENTIAL FUNCTIONS : •Develop and maintain administrative and clinical operations that provide quality care and outcomes for the patients. •Contribute to the planning and implementation of program goals, objectives, personnel, resources and equipment. Implement the approved program plan objectives, timetables, expected outcome and measures for as
Job Source: Acadia HealthcareFreshworks
San Mateo, CA, United States
Company Description Freshworks makes it fast and easy for businesses to delight their customers and employees. We do this by taking a fresh approach to building and delivering software that is affordable, quick to implement, and designed for the end user. Headquartered in San Mateo, California, Freshworks has a global team operating from 13 global
Job Source: FreshworksLogicMonitor
San Francisco, CA, United States
Product Management, San Francisco, CA About Us LogicMonitor is the leading fully automated, cloud-based infrastructure monitoring and observability platform for enterprise IT and managed service providers. We love going to work and think you should too. We are customer obsessed, work as one agile team, and strive to be better every day while bui
Job Source: LogicMonitorNFF Board
San Francisco, CA, United States
Position Reports to: Director, Portfolio Management Location: Preference is for the position to be in commutable distance to one of NFF’s office locations which are Boston, Los Angeles, New York, Oakland, and Philadelphia. Remote locations will be considered. Department : Financing For over 40 years, Nonprofit Finance Fund has pr
Job Source: NFF BoardOakland, CA, United States
Highland General Hospital Manager, Care Management Oakland , California Apply Now Alameda Health System offers great benefits to our employees!
100% employer health plan for employees and their eligible dependents
Unique benefit offerings that are partially or 100% employer paid
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 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.
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 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 payers 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.
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 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
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Manager, Care Management jobs in Oakland, CA, United States
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