Case Management Supervisor; CASE MGT HC SUPV

Overview

The supervisor must provide administrative assistance to the department Manager in the provision of complex interactions interdepartmentally and externally that are encountered by the clinical case management staff. This position requires a high level of management skills, clinical judgment, problem solving skills, creativity, organizational and priority setting abilities with excellent communication skills. Critical aspects of the role involve the assessment of departmental needs for effective resource utilization and personnel management.

The incumbent must also employ extensive clinical knowledge and expertise to determine if case management and/or utilization management services provided to the patients by the department are timely, appropriate, and effective. The incumbent must provide both direct and indirect support to meet the goals of coordinated clinical case management by actively directing and involving members of the multi-disciplinary team, outside providers, community resources and third-party payors.

The incumbent is responsible to administratively support the manager in assuring the department has adequate, well-trained, professional, and effective staffing as well as in the management of the department budget. The Clinical Case Management Department participates in multiple committees, both internally and externally, representing Clinical Case Management (CCM) Department and the University.

• Valid California Registered Nurse License without restriction
• Bachelor's degree in Nursing (BSN)
• 5 years clinical experience in an acute care hospital with 2 years in Discharge Planning and/or Utilization Management
• 2 years experience in a leadership or supervisory role in a healthcare organization or system
• Complete working knowledge of, and skill to apply practices, principles, and techniques of patient care, authorization needs, as pertaining to areas of responsibilities
• Knowledge of Medicare, Medi Cal, Insurances, and HMO legislation, third party payor contracts, Title XXII, JCAHO, and CMS criteria. Demonstrated knowledge of how these programs/regulations effect the functions and role of the department; ability to incorporate them into departmental systems/processes
• Knowledge of the Nurse Practice Act and/or National Association of Social Workers Standards for Social Work Practice and the responsibilities related to coordination of discharge planning services across the continuum
• Knowledge of Case Management Society of America’s Standards of Professional Case Management Practice and/or American Case Management Association’s Standards of Practice and Scope of Services
• Knowledge of evidence-based screening tool to assess for medical necessity in the acute setting
• Knowledge and comprehension of federal, state, and licensure regulations, including Title XXII, JCAHO, and EMTALA guidelines. Demonstrated knowledge of how these regulations affect the functions and role of the department; ability to incorporate them into departmental systems/processes
• Broad based clinical skills, enabling a broad area of assessment, planning, and intervention as it relates to overall responsibilities
• Ability to read and comprehend English text and medical terminology; knowledge of medical and nursing treatment plans, levels of care and Health System resources to effectively perform departmental responsibilities and act as a resource to physicians and staff; skill in assessing the appropriateness of medical admissions and continued stay
• Skill to perform in-depth analysis of medical records and other documents to determine accurate information in a concise, informative manner, and to identify/analyze problems or issues related to areas of responsibility
• Ability to organize and direct varied health care team professionals in a manner that establishes a good rapport and professional working relationship
• Leadership skills to work as part of a team, collaborate with colleagues, and direct others to accomplish tasks in a positive manner, which are conducive to positive operations within the department, maintain a positive rapport with peers and staff, and motivate cooperation of staff while…