Director of Case Management - Utilization Management

Prime Healthcare; Inglewood (CA); On-site; USD 108,000 - 164,000; Full time

Benefits offered by this job

Paid Time Off

401K retirement plan

Medical

Dental

Vision Coverage

Tuition Reimbursement

Voluntary Benefit Options

Job summary

Centinela Hospital Medical Center, part of Prime Healthcare, is seeking a strategic Director of Case Management to lead a multi-disciplinary team of registered nurses, social workers, and clinical coordinators. You will oversee utilization management, discharge planning, and care coordination to ensure timely, appropriate care across the hospital stay.

The ideal candidate has CA RN license, BSN, and five years in case management plus familiarity with Milliman and InterQual criteria.

Qualifications

• CA Registered Nurse licensure and active credentials.

Responsibilities

• Lead the Case Management Team including RNs, Social Workers, and Clinical Coordinators.
• Oversee utilization management, discharge planning, and care coordination.
• Develop staff and systems to operate a comprehensive Case Management Program.
• Provide leadership and supervision to case management staff and related roles.
• Coordinate services using continuous quality improvement tools.

Skills

CA Registered Nurse

BSN

LCSW (Licensed Clinical Social Worker)

Milliman Criteria

InterQual Criteria

Education

Bachelor of Science in Nursing

Licensed Clinical Social Worker (LCSW)

Tools

Milliman Criteria

InterQual Criteria

Job description

Overview

At Centinela Hospital Medical Center, our dedicated team of professionals are committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, a Top-15 hospital system in the United States, Centinela Hospital Medical Center is actively seeking new members to join its award-winning team!

Centinela Hospital Medical Center has been serving the communities of Inglewood and the wider Los Angeles area for 100 years. An award-winning facility, ranking in the top 5% nationally for quality and patient safety, Centinela Hospital is a 362-bed acute-care hospital with a 24-hour STEMI certified emergency department and primary stroke center, orthopedic care, advanced cardiac services, critical care services, inpatient and outpatient rehab programs, and more. Centinela has earned hundreds of national awards and recognitions, including"100 Top Hospital"recognition from Fortune/Merative and straight 'A's (2018-2022) for hospital safety from The Leapfrog Group.For more information, visitwww.centinelamed.com.

Why Prime Healthcare?Centinela Hospital Medical Center;a member of Prime Healthcare, offersincredible opportunities to expand your horizonsand be part of a community dedicated to making a difference.

Centinela Hospital Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs.

Our Total Rewards package includes, but is not limited to:

• Paid Time Off
• 401K retirement plan
• Outstanding Medical
• Dental
• Vision Coverage
• Tuition Reimbursement
• Many moreVoluntary Benefit Options!

Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time.

Responsibilities

We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management Team consisting of Registered Nurses, Social Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patients receive timely, appropriate, and efficient care throughout their hospital stay. The Director is responsible for the development of staff and systems to effectively operate a comprehensive Case Management Program. The Director provides leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Additionally, this leader assesses needs and plans, communicates and designs services that are appropriate to the hospital mission and patient/family needs. The Director of Case Management ntegrates and coordinates services using continuous quality improvement tools.

Preferred leadership style and ideal candidate is a forward-thinking professional who thrives in a collaborative, fast-paced healthcare setting and is passionate about driving positive patient outcomes and reducing readmissions.

#LI-CC2

Qualifications

Required qualifications:

• 1. CA Registered Nurse
• 2. Bachelor's of Science in Nursing
• 3. Grandfathered prior to April 1, 2015. Minimum 5 years’ post graduate of an accredited school of Social Work for Licensed Clinical Social Worker.
• 4. Minimum 5 years’ experience in a Case Management position.
• 5. Must have analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process.
• 6. Experience and knowledge in basic to intermediate computer skills.
• 1. Current BCLS certificate preferred.
• 2. Knowledge of Milliman Criteria and InterQual Criteria preferred.

Pay Transparency

Centinela Hospital Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $108,160.00 to $163,800.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf