DaVita Manager, Reg Inpatient Case Management (RN) - Costa Mesa in COSTA MESA, California

Manager, Reg Inpatient Case Management (RN) - Costa Mesa

Description

OVERVIEW OF POSITION

Responsiblefor the oversight, management and optimization of all quality improvement,utilization management and care management activities as it relates topre-admission, ambulatory case management, inpatient, social service, homehealth, health education, behavioral health and other health care deliveryprograms within Health Care Partners Medical Group. Manages staff directly responsible for theday-to-day operations of the care management programs. Contributes to the clinical, quality,financial and patient satisfaction outcomes of the region. Works closely with all members of the CareManagement team as well as members of Health Enhancement, Quality Improvement,Contracting and the Office of the Medical Director to ensure compliance withall regulatory requirements.

ESSENTIAL FUNCTIONS:

  • Consistently exhibits behavior and communicationskills that demonstrate HealthCare Partners’ (HCP) commitment to superiorcustomer service, including quality, care and concern with each and everyinternal and external customer.

  • Identifies need for and participates in thedevelopment and implementation of care management and utilization managementpolicies and procedures, and ensures compliance throughout the region.

  • Monitors the utilization of inpatient andoutpatient services and ensures coordination of all ambulatory care managementservices with pre-admission, home health, health education and other ambulatoryservices.

  • Closely monitors and analyzes all inpatient andoutpatient reports and identifies trends. Makes recommendations to the Vice President/Director, Regional CareManagement regarding interventions to improve all resource management.

  • Facilitates team process problem resolution usingHCP administration, Medical Directors, Contracting, Risk Management, BehavioralHealth and health plans regarding complex patient issues. Implements the results of the collaborationprocess.

  • Oversees and monitors patient eligibility, financialcontract accountability and health plan benefit determination for each patientreferral. Facilitates resolution onareas of conflict.

  • Prepares the department for accreditation surveysusing the appropriate standards of performance. Ensures utilization management compliance with DMHC/CMS/NCQArequirements.

  • Leads activities related to the utilization reviewprocess in conjunction with the local Care Management Committee Provider Chair.

  • Designs, implements and facilitates data andstatistical collection including outcome and quality of care information.

  • Monitors all high risk/high cost patients in regardto care delivery, referrals, contracting, etc. Monitors provider referral patterns for appropriate utilization ofspecialty and ancillary services.

  • Provides supervision and guidance to Supervisor andstaff reporting to the position.

  • Conducts monthly staff meetings includingutilization management review outcome measurements and identification oftraining/educational opportunities.

  • Identifies, develops and oversees the educationalneeds of Care Management staff, providers and others. These include an extensive orientationprogram, cross-training and proactive approach to case management.

  • Identifies opportunities for the development of newcare management approaches and prepares proposals with cost analyses, ISrequirements, education and implementation plans.

  • Contributes to the Care Management business planand budget process along with the Vice President/Director, Regional CareManagement.

  • Coordinates or performs projects/activities asdelegated by organizational committees and Vice President/Director, RegionalCare Management.

  • Uses, protects, and discloses HCP patients’protected health information (PHI) only in accordance with Health InsurancePortability and Accountability Act (HIPAA) standards.

  • Performs additional duties as assigned.

Qualifications

EDUCATION:

  • Bachelor’s degree from a four-year college and/or aprofessional certification requiring formal education beyond a two-yearcollege.

  • Graduate from an accredited school of Nursing.

  • Current California RN license.

  • Bachelor’s degree in Nursing or related fieldpreferred.

EXPERIENCE:

Minimum:

  • Over 3 years and up to and including 5 years of experience.

  • 3 to 5 years prior acute nursing experience.

Preferred:

  • 3 to 5 years prior acute nursing with critical careexperience.

  • 2 to 4 years managed care/HMO experience inutilization review, case management or discharge planning.

  • 2 to 3 years management experience in utilizationreview, case management or discharge planning.

KNOWLEDGE, SKILLS, ABILITIES:

  • Computer literate.

  • Proficient in Microsoft applications (Word, Excel,Access).

  • Knowledge of medical/nursing standards of care.

  • Working knowledge of CMS, NCQA, DMCH, HEDIS,medical and regulatory agency guidelines.

  • Excellent verbal and written communication skills.

  • Ability to effectively collaborate with physicians,patients/families and ancillary staff.

  • Strong oral/written analytical and problem-solvingskills with ability to make sound and independent judgments.

  • Ability to act professionally under pressure.

DaVita Medical Group manages and operates medical groups and affiliated physician networks in California, Colorado, Florida, Nevada, New Mexico, Pennsylvania and Washington. A leading independent medical group in America, DaVita Medical Group has over two decades of experience providing coordinated, outcomes-based medical care in a cost-effective manner. As of December 31, 2016, DaVita Medical Group’s teammates, employed clinicians and affiliated clinicians provided care for approximately 1.7 million patients. DaVita Medical Group’s leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu.

DaVita Medical Group is an equal opportunity/affirmative action employer. As such, DaVita Medical Group makes hiring decisions solely on the basis of qualifications and experience, and without regard to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.

DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.

WARNING: Job Recruitment Scam Notice

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Learn More

Primary Location CA-COSTA MESA - 92626

Req ID: 327630