Manager Of Outpatient Case Management

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

• Essential Duties and Responsibilities include the following:

1.Oversees day-to-day activities, care coordination and provision of Outpatient Case Managers.

2.Has direct oversight responsibility and accountability of the program and department of case management and ancillary staff in RMG North.

3.Manages and monitors enrollees assigned to Outpatient Case Management programs to ensure efficient and timely delivery of care, timely referrals, and moving the enrollee's treatment plans through the care continuum.

4.Develop a standardized process for triaging and enrollment of appropriate members into Outpatient Case Management programs for RMG North.

5.Identifies and develops program and department policies and procedures and ensures compliance and consistency throughout RMG regional sites.

6.Develops and coordinates program and department strategies for ensuring the delivery of care in the most cost effective setting.

7.Develops, monitors, and analyzes program and department reports and identifies trends to improve clinical and utilization and quality outcomes.

8.Develops annual program and department goals and objectives focused on improving patient outcomes and efficiency.

9.Implements tools and processes that direct and role model a high level of customer service behavior toward enrollees.

10. Works collaboratively with the entire Medical Management team to ensure that Employer company goals as well as compliance with regulatory and health plan requirements are met.

11. Act as a resource for hospitalists, SNFs, outpatient utilization management staff, home health care agencies, Employer home-visit physicians and nurse practitioners.

12. Training, mentoring, auditing of the clinical competency, productivity, contribution, customer service interaction of Program and Department professional and non professional staff. Act as a resource to all staff members of the Program and Department.

13. Motivates, instructs, mentors, audits and leads and constantly improves the quality of service and clinical outcomes rendered by the Employer's Outpatient Case Management staff.

14. Provide regular audit reports on Program and Department staff and action plans to improve efficiency and efficacy.

15. Manager shall be based in the Northridge site. Manager's service area jurisdiction and responsibilities may be expanded and/or changed at Employer's discretion.

16. All other duties as directed by management.

• Education and/or Experience:

1.Graduate from an accredited Registered Nursing Program.

2.Current CA RN license, current CPR certification, valid CA Driver's license.

3.4-5 years of previous management experience required.

4.3 years acute care or case management experience preferred.

5.2-3 years of HMO experience preferred.

6.Must have experience in managing high risk cases.

7.High level knowledge of Case Management processes and principles

8.Prior experience in MSO environment preferred.

9.Ability to work with all levels of management.

10. Must have excellent verbal and written communications skills.

11. Must have excellent organizational skills.

12. Must have prior experience with project development and implementation.

13. Must have working knowledge of MS Office environment

14. Requires current CA driver's license and car insurance

We offer a full benefits package which includes employer paid medical, pharmacy and dental benefits. We offer a generous PTO package, 401k Retirement Savings, Life Insurance, Flexible Spending Account (FSA), Tuition Reimbursement & Licensed Renewal Fees for our clinical staff.

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.