Supervisor - Case Management II Supervisor
Company: Community Health Group
Location: Chula Vista
Posted on: October 23, 2024
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Job Description:
POSITION SUMMARY Provides supervision to the Clinical Case
Managers in Community Health Group's (CHG's) High Risk Case
Management program, and is responsible for the optimal and timely
delivery of proactive and collaborative case management and care
coordination activities. COMPLIANCE WITH REGULATIONS Works closely
with all departments necessary to ensure that the processes,
programs and services are accomplished in a timely and efficient
manner in accordance with CHG policies and procedures and in
compliance with applicable state and federal regulations including
CMS and/or Medicare Part D, DHCS and DHMC. RESPONSIBILITIES
Supervises staff in day-to-day functions, including training and
developing the case management and care coordination staff to
accomplish program goals and objectives. Assists in the
development, maintenance, and implementation of metrics to appraise
the productivity and quality of staff performance. Supervises the
management and care coordination of identified high risk members to
reduce recurrent and unnecessary hospital admissions, readmissions,
and emergency room visits. Works in close collaboration with
Interdisciplinary Care Team and contracted physician groups who
conduct assessments to establish members care needs. Supervises the
process to promote smooth transitions of care for targeted members.
Coordinates individually needed interventions for select members
based upon CHG established indicators. Provides guidance to case
managers and care coordinators with difficult cases and situations;
assumes responsibility of cases when risk management issues are
identified. With the Health Care Services management team, works to
develop, implement, and evaluate interventions designed to enhance
member outcomes, quality metrics, and increase customer
satisfaction. Functions as a resource to internal and external
customers. EDUCATION Graduate from an accredited school of nursing
or other clinical related field required BA degree in health
related field preferred Certification in case management preferred.
EXPERIENCE/SKILLS 2 years' experience as a high risk case manager
and 1-year experience in a managed care environment, hospital
discharge planning or outpatient clinic is required. 1 year of
supervisory experience preferred. Knowledge of population health,
care/case management clinical operations, and management expertise
relating to business planning, process improvement, budget
administration, and personnel management. Working knowledge of
Microsoft programs; proficiency with Word and Excel. Knowledge of
managed care principles, CPT, ICD-10, HCPCS coding, experience with
inpatient and outpatient medical review guidelines (MCG). Familiar
with Medi-Cal, Medicare. Familiar with Web based standard of care
sites i.e. NIH, ACOG. Ability to communicate effectively verbally
and in writing; exceptional telephone and customer service skills;
ability to establish effective working relationships with
physicians and medical professionals; May be required to conduct
in-person visits and assessment of members. OTHER REQUIREMENTS
Prolonged periods of sitting at desk; intermittent standing,
walking and bending. May be necessary to work and attend meetings
outside of facility or normal business hours. Lifting 10 lb. or
less. Driving within County of San Diego California driver's
license in good standing. **Must have current authorization to work
in the USA** Community Health Group is an equal opportunity
employer that is committed to diversity and inclusion in the
workplace. We prohibit discrimination and harassment based on any
protected characteristic as outlined by federal, state, or local
laws. This policy applies to all employment practices within our
organization, including hiring, recruiting, promotion, termination,
layoff, recall, leave of absence, compensation, benefits, and
trainings. Community Health Group makes hiring decisions based
solely on qualifications, merit, and business needs at the time.
For more information, see Personnel Policy 3101 Equal Employment
Opportunity/Affirmative Action The above statements are intended to
describe the general nature and level of work being performed. They
are not intended to be construed as an exhaustive list of all
responsibilities, duties and skills required of personnel so
classified. Employment Type: Full Time Salary: $82,473 - $96,906
Annual Bonus/Commission: No
Keywords: Community Health Group, Paramount , Supervisor - Case Management II Supervisor, Executive , Chula Vista, California
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