Job Summary :
Direct function and personnel of the care management department. Develops, manages, and oversees the annual care management budget.
Prepares and evaluates monthly, quarterly, and annual reports of the department's functions. Monitors and reports on changes in Medicare regulations and documentation issues to physicians and others as needed.
Maintains relationships and contractual oversight with key stakeholders, local, state, and federal agencies.
Job Requirements :
Education and Work Experience :
- Bachelor’s Degree or equivalent combination of education / related experience : Required
- Master's Degree : Preferred
- Seven years' hospital discharge planning, utilization review, case management and social work experience : Preferred
- Five years' leadership experience : Preferred
Licenses / Certifications :
- Registered Nurse (RN), Medical Degree (MD) or (DO) and currently licensed to practice, without restriction, in the State of California or Licensed Clinical Social Worker (LCSW) : Required
- Licensed Master Social Worker (LMSW) - State Board : Preferred
- Registered Nurse (RN) or Medical license MD (MD) or Medical license DO (DO) or Licensed Clinical Social Worker (LCSW) : Required
Essential Functions :
- Develops the care management team and motivates them to accomplish department goals and objectives.
- Develops, manages, and oversees the annual care management budget. Prepares and evaluates monthly, quarterly, and annual reports of the department's functions.
- Provides information regarding changes in Medicare regulations and documentation issues to physicians and others as needed.
Analyzes and monitors utilization metrics and communicates findings as appropriate.
- Oversees accountability for on-site monitoring reviews by outside review organizations and third-party payers.
- Maintains relationships and contractual oversight with key stakeholders, onsite and enterprise-wide, including education and monitoring of utilization patterns.
Maintains working relationships with local, state, and federal agencies.
Performs other job-related duties as assigned.
Organizational Requirements :
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc.
as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.
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