Supervisor Case Management / Utilization Management at Community Memorial Healthcare

San Buenaventura (Ventura), California, United States -

Full Time

Start Date

Immediate

Expiry Date

17 Feb, 26

Salary

89.96

Posted On

19 Nov, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Leadership, Collaboration, Motivational Skills, Data Analysis, Outcome Measurement, Action Plan Development, Bilingual in Spanish, InterQual, Allscripts, Meditech

Industry

Hospitals and Health Care

Description

Compensation Salary Range: $58.97 - $89.96 per hour The pay range above represents the lowest possible rate for the position and the highest possible rate. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. If you are viewing this posting on a job site, please visit our company page and search for the opportunity to view the pay range: https://careers-mycmh.icims.com/jobs Responsibilities Position Overview: The Supervisor Case Management/Utilization Management supervises the Case Management team charged with quality member outcomes, optimizing benefits and promoting effective use of resources. The position demonstrates competency in covering all positions within the Case Management/Utilization Review Department and floats when assigned to ensure appropriate coverage of Case Management/Utilization Review needs. The Supervisor Case Management/Utilization Management ensures that care is medically appropriate, high quality and cost effective. Participates in completion of reviews and appeals, including Treatment Administration Records (TARs). Accountable for the oversight, development and maintenance of the department’s Case Management processes. The position provides assistance with the management of the Case Management Department when the Manager is out of the office. Completes the daily staffing work sheets and assists with training of new staff. Participates in projects, meetings and committees as assigned. Qualifications Required: Current CA Registered Nurse (RN) license Three (3) years of recent Case Management and Utilization Review experience in the acute care setting, or an equivalent combination of education and experience Preferred: BSN Certified Case Manager Strong leadership, collaboration and motivational skills Ability to analyze data, measure outcomes and develop action plans Bilingual in Spanish Previous experience with InterQual Previous experience with Allscripts and Meditech Essential Functions and Responsibilities: Responsible for supervision of Case Management/Utilization Review staff. Acts as a role model to staff and is able to assist in day to day activities as needed. Supervises and coordinates all departmental activities, including staff education, policy and procedure development and revision. Oversees all operations to ensure compliance to standards. Acts as liaison between physicians, nursing, other hospital departments, community agencies, health plans and patients/families. Works closely with other CMHS departments to resolve issues and ensures activities align with Case Management processes in place. Develops and implements appropriate audit requirements in order to ensure compliance with all staff activities related to Case Management/Utilization Management. Assists with creating daily assignments of Case Managers. Ensures appropriate distribution of workload, monitors and tracks staff completion of assigned tasks. Acts as a resource to Case Managers; is first line support to staff to problem solve every day issues related to departmental activities. Handles difficult/complex cases as assigned by Manager. Suggests new approaches to complex problems. Assists with timely completion of TARs, appeal letters and Utilization Reviews. Participates in the interview process of Case Management candidates. Trains, coaches, counsels, and evaluates performance of direct reports. Assists with new hire training. Assists Manager with orientation and documentation of new employees when needed. Participates in the development and collection of data for Performance Improvement projects and Corrective Action Plans. May participate on task forces and committees as requested. Accountable for special projects and enhanced activities within the department. Performs other duties as assigned. Overview When it comes to quality, we're 5 Star! Community Memorial Health System was established in 2005 when Community Memorial Hospital in Ventura merged with Ojai Valley Community Hospital. It is comprised of these two hospitals along with a network of primary and specialty care health centers serving various communities across west Ventura County. Our health system is a community-owned, not-for-profit organization. As such, we are not backed by a corporate or government entity, nor do we answer to shareholders. We depend on – and answer to – the communities we serve. Community Memorial Hospital – Ventura has been awarded a prestigious five-star rating by the Centers for Medicare & Medicaid Services (CMS)! This achievement represents thousands of people going the extra mile every day for our patients, and we are the ONLY hospital in Ventura County to earn this distinction! Community Memorial Healthcare Benefits To help heal, comfort, and promote health for the communities we serve, Community Memorial Healthcare takes care of our community of employees so our local community can be cared for. That’s why we provide competitive benefits, along with great career choices, training, and leadership development. Our total rewards package provides benefits that support you and your family’s health and wellness in all aspects of life. From our top tier insurance plans to our employee assistance program, take advantage of what CMH has to offer so you and your loved ones can have peace of mind now and for years to come. CMH is here for you and your family every step of the way. Competitive Pay Shift Differentials In-House Registry Rates Fidelity 403(b) Retirement Plan Paid Time Off Medical (EPO/PPO), Dental, & Vision Insurance Coverage Voluntary Worksite Benefits Employee Assistance Program Available 24/7 (EAP) Tuition Reimbursement Public Service Loan Forgiveness (PSLF) Recognition programs Employee service recognition events Home, Retail, Travel & Entertainment Discounts National Hospital Week and National Nurses Week celebrations Community Memorial Healthcare is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation. We strive to promote an environment where exceptional people bring diverse perspectives and find belonging, support and connection to their work in our community. “We are an AA/EEO/Veterans/Disabled Employer”

Responsibilities

The Supervisor Case Management/Utilization Management supervises the Case Management team to ensure quality member outcomes and effective resource use. This role includes overseeing departmental activities, staff education, and compliance with standards.