Cedars-Sinai Manager Case Management in Los Angeles, California
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Tell Me About This Role:
The Manager, Case Management manages the day to day operations for the care coordination team and works closely with the interdisciplinary and administrative team to align care coordination operations with department and organizational goals and targets. The Manager, Case Management collaborates with the case management Medical Director as well as the utilization management team and social work leadership team. May have frequent contact with Nurse Executives and Directors, Quality Directors, Ancillary Services directors, finance department, Medical Directors, physicians, contracted providers, community resources as well as patients and family members.
Provides leadership and oversees supervisors, case management staff and resource personnel.
Reviews cases frequently with staff, acts as clinical consultant regarding care management issues, guides clinical staff with review of assessments and care plans and evaluates utilization reviews or documentation.
In conjunction with VP, Director and/or other leadership, coordinates, develops, and implements action plans to respond to areas in need of improvement related to patient flow and care coordination across the continuum.
Assists leadership in establishing, implementing and ensuring that care management policies, practices and procedures are in accordance with the Joint Commission, Title 22 and other regulatory agencies and overall hospital policies (Title 9, CMS/Medicare guidelines, EMTALA, HIPAA, etc.).
Monitors required metrics, including but not limited to length of stay, readmissions, observation stays, avoidable delays; conducts documentation audits.
Participates in development and implementation of case management policies, workflows, processes.
Participates, develops and monitors performance improvement plans including key performance indicators.
Demonstrates and ensures knowledge of staff regarding medical necessity, regulatory requirements and standards, such as Joint Commission.
Utilizes demonstrated knowledge of acute case management, care coordination & discharge planning roles and responsibilities.
Coordinates the collaboration and integration of social services & care coordination functions.
Drives and supports change management for all initiatives.
Manages the effective utilization of human resources within care coordination, including, working with Supervisor to adjust staff assignments daily. Develops staffing plans in response to unscheduled sick-calls, vacation requests and other occurrences.
Education and Certifications:
Bachelors Degree in Nursing required. Masters Degree in Nursing preferred.
California State Nursing License required
Case Management Certification required: Certified Case Manager (CCM), Accredited Case Manager (ACM), or ANCC Nurse Case Manager (RN-BC)
5 years' Leadership experience in acute care Case Management required.
3 years' experience and knowledge of InterQual and MCG Criteria, as well as utilization required.
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.