District Manager, Clinical Resource Management

Palomar Health; Escondido (CA); On-site; USD 116,000 - 183,000; Full time

Job summary

Palomar Health in Escondido, CA is seeking a Manager of Clinical Resource Management (Case Management/Utilization Review) to lead the Care Management team and coordinate patient care across departments. The role focuses on optimizing clinical outcomes and financial performance while maintaining high quality care and efficient discharge planning.

You will supervise case managers and social workers, manage staffing and performance, and work with payers and providers to ensure compliant and

Qualifications

• Bachelor's Degree in Nursing or related healthcare field required.
• Master's degree preferred.
• Minimum 2+ years recent management/leadership experience.
• 4+ years experience in Acute Hospital Case Management and/or Utilization Review.
• American Heart Association BLS - Healthcare Provider certification required.
• Certified Case Manager certification preferred.
• Current CA RN License required.

Responsibilities

• Oversee and coordinate clinical resource management, case management and utilization review.
• Supervise case managers and social workers; manage staffing and scheduling.
• Collaborate with hospital departments and payers to ensure coordinated care.
• Analyze patient care and financial outcomes; present findings to leadership.
• Support discharge planning and ensure compliance with policies and standards.

Skills

Leadership

Staff coordination

Communication skills

Analytical thinking

Problem solving

Education

Bachelor's Degree in Nursing or related healthcare field

Master's Degree in Healthcare related field

Tools

MS Windows

Excel

Access

Word

PowerPoint

Internet

Email

Job description

Department: Clinical Resource Management Union: Shift: 8-hour Shift - Day (United States of America) Hours Per Pay Period: 80 Salary Range: $55.64 - $88.22

Job Description

The Manager, Clinical Resource Management (Case Management or Utilization Review) supervises, facilitates, and coordinates the Care Management systems, and supports the Palomar Health Strategic Plan across the district. This includes all the activities of the Case Managers and Social Workers. The position evaluates the patient care outcomes as well as the financial outcomes this system impacts. This position collaborates with all hospital departments within Palomar Health; medical staff, Home Health Care/Hospice agencies; durable medical equipment companies; nursing homes; and others to assure patient care coordination is efficient, of high quality and cost effective. He/she is responsible for the operational functions of the department including staffing, scheduling, performance management and financial/productivity. This position assists in teaching others how to analyze patient care data and how to present it to reach the goals of the organization. The position is required to work with all financial payers for reimbursement and excellent discharge planning. He/she follows Palomar Health's Values and assures that these standards are followed by the department's associates. Actively participates in development and monitoring of strategic initiatives as defined by the CRM leadership team. Speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, Powerpoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, and quality commitment of Palomar Health.

Job Requirements

• Minimum Education: Bachelor's Degree in Nursing/or related healthcare field.
• Preferred Education: Master's Degree in Healthcare related field
• Minimum Experience: 2+ years recent management/leadership experience
• 4+ years experience in Acute Hospital Case Management and/or Utilization Review
• Preferred Experience:
• Required Certification: American Heart Association recognized BLS - Healthcare Provider
• Preferred Certification: Certified Case Manager
• Required License: Valid Driver's License Current CA RN License
• Preferred License: Not Applicable

We are an equal opportunity employer and do not discriminate against applicants or employees based on race, color, gender, religion, creed, national origin, ancestry, age, disability, sexual orientation, marital status or any other characteristic protected by law.

Palomar Health invites you to be part of our healthcare team, where we offer extraordinary opportunities for both clinical and non-clinical positions. As a leading healthcare system, we are committed to providing world-class care to our community. When you join our team, you'll have access to our exceptional training programs designed to help you excel in your role and grow your career.