We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.
The Director of Case Management is responsible for the development of staff and systems to effectively operate a comprehensive Case Management Program. Provides leadership and supervision to case managers, social workers and case management coordinators. Assesses needs and plans, communicates and designs services that are appropriate to the hospital mission and patient/family needs. Integrates and coordinates services using continuous quality improvement tools.
Directs supervises and evaluates the operations of the Case Management, Social Services and Denial Management/Recovery Audit Contractor (RAC)/Nurse Auditing programs.
Is responsible for annual budget development, new program development, establishing department policies and procedures, department goals and objectives.
Maintains quality assurance. Promotes and coordinates department Quality Improvement and coordinates activities with other departments to provide and maintain optimal standards of patient care.
Responsibilities include the assurance that the staff adheres to the Corporate Compliance Program, to the rules and regulations of all local, state and federal guidelines and to the standards of accrediting bodies.
Works with the Administrative Team and Utilization Review Committee to set financial goals (LOS, etc.). Is responsible for the implementation and supervision of the process of achieving these goals.
Creates and implements systems of communication between Access Care Services, Business Office, Medical Records, Nursing Units, Emergency Department, Bed Control, Social Services, and other departments that increases the efficiency and effectiveness of the case management and social services processes. These systems should assist in achieving the goals, policies and procedures, and processes described in 1, 2, and 3 above.
Responsible for the training and supervision of social services and case management staff. This includes organizing, planning and establishing procedures and policies to remain in compliance with published federal, state, county and Joint Commission regulations.
Represents the hospital in medical staff committee meetings as it relates to case management and social services.
Represents the hospital in administrative meetings established to enhance the working relationship with contracted providers (IPA, Health plans, Medical Group etc.)
Assures compliance with federal and state regulations and accordance with the hospital's Utilization Management, Quality and Risk Management Plans.
Aggregates and analyzes data generated by and submitted to the Case Management Department as required by the Medical Staff, Administration and outside agencies.
Exercises primary responsibility for the annual review and approval of the Case Management plan, by the appropriate medical committees, Administration and the Governing Board in accordance with the Joint Commission Standards and Accreditation.
Prepares and manages the department's’ annual operating budget. Fiduciary responsibilities include approval of rental or purchase of all capital items.
Minimum Education: Minimum five (5) years post Graduate of an Accredited School of Nursing. BS or BSN or related field preferred
Minimum Experience: Required to have a minimum of five (5) years experience in a Case Management position. Must have analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process.
Req. Certification/Licensure: Current California RN License. Certification in Case Management, . Current American Heart Association (BLS) Certification. Current Behavioral Violence Prevention Training within three (3) months of hire and maintain.
Employee Value Proposition
Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:
Medical, dental, vision insurance
How to Apply
To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!
We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.
EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm