MANAGER - CASE MANAGEMENT/SOCIAL SERVICES

SAN-Gorgonio-Memorial-Hospital; Banning (CA); On-site; USD 108,000 - 141,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

403(b) Retirement

PTO

Wellness resources

Professional development

Job summary

San Gorgonio Memorial Hospital is seeking a Manager of Case Management and Social Services to lead the CM and Social Services departments, overseeing patient care coordination, discharge planning, and utilization management. This role requires leadership over a multidisciplinary team and collaboration with physicians and executives.

The position emphasizes improving patient flow, reducing readmissions, and ensuring regulatory compliance.

Qualifications

• Bachelor’s degree in Nursing (BSN), Social Work (BSW), Healthcare Administration, or another healthcare-related field.
• Three (3) years of progressively responsible experience in acute care case management, utilization management, social services, care coordination, or discharge planning in hospital settings.
• Knowledge of CMS Conditions of Participation, Joint Commission standards, California Title 22 regulations, utilization review, discharge planning, and payer requirements.
• Experience leading both Case Management and Social Services departments.
• Experience with value-based care, population health, denial management, and multidisciplinary care coordination.
• Experience with electronic health records, case management software, and performance improvement initiatives.

Responsibilities

• Assists with daily operations and scheduling within CM/Social Services.
• Liaisons with Medi-Cal Managed Care, medical records, and central business office.
• Develops and maintains CM policies and procedures.
• Coordinates with outside agencies and facilitates 5150 training.
• Oversees CM/UM plans, risk management activities, and reporting.
• Maintains performance metrics and collaborates across departments.

Skills

Customer service

Interpersonal skills

Communication skills

Leadership

Critical thinking

Conflict resolution

Education

Bachelor's degree in Nursing (BSN)

Bachelor's degree in Social Work (BSW)

Healthcare Administration

Job description

MANAGER - CASE MANAGEMENT/SOCIAL SERVICES FEATURED

4324

Case Management (UM/DP)

Full Time , Day Shift , MON-FRI; 8AM-4:30PM; Salaried/Exempt; Pay Range=$52 to $68.00, DOE.

Position Summary

The Manager of Case Management &Social Servicesis responsible forthe overall leadership, management, and daily operations of the Case Management and Social Services departments. This position provides strategic and operational oversight to ensure the delivery of high-quality, patient-centered care coordination, discharge planning,utilizationmanagement, and psychosocial services across the continuum of care. The Manager collaborates with physicians, nursing leadership, ancillary departments, post-acute providers, and community agenciesto promote safe,timely, and efficient patient transitions while supporting regulatory compliance, quality outcomes, and financial stewardship.

The Manager oversees a multidisciplinary team of registered nurse case managers, licensed clinical social workers, social workers, case management assistants, and other support staff. Responsibilities include supervising departmental operations, developing and implementing policies and procedures,monitoringkey performance indicators, managing departmental budgets, ensuring compliance with federal, state, and accreditation standards, and fostering a culture of collaboration, accountability, and continuousimprovement.

This role is instrumental in reducing avoidable hospital days, improving patient flow, minimizing readmissions,optimizingresourceutilization, and enhancingthe patientand family experience. The Manager serves as a key leader in interdisciplinary care coordination,utilizationreview, complex discharge planning, population health initiatives, and value-based care strategies. The position also works closely with executive leadership to achieve organizational goals related to quality, patient safety, operational efficiency, regulatory compliance, and financial performance.

The Manager of Case Management & Social Services promotes professional development, staff engagement, and evidence-based practice while ensuringequitableaccess to healthcare resources and advocacy for patients and families. This leader is expected tomaintainstrong relationships with skilled nursing facilities, home health agencies, hospice organizations, community resources, behavioral health providers, and payer organizations tofacilitateseamless transitions of care and improve health outcomes.

What You'll Do (not all inclusive)

• Assumes a leadership/supervisory role byassistingwith the daily operations/functions of the department including scheduling, InterQual reviews, staff assignments, orientation ofnew staffmembers, and completion of Treatment Authorization Request (TAR) forms.
• Functions as the liaison to the Medi-Cal Managed Care program, medicalrecords,and the central business office.
• Develops andmaintainsCase management policies and procedures.
• Collaboratesin writing appeals fordenials,as necessary.
• Coordinates with outside agencies including but not limited to CPS/APS and psychiatric services andsharesinformation with associates.
• Coordinates Riverside County 5150 training and certification process for all SGMHdesignated5150 evaluators.
• Under the direction of the Chief Nursing Officer, generates, revises, and updates Utilization Management plans, policies, and procedures and coordinates the implementation of Case Management/Risk Management/Utilization Management activities within the hospital.
• Assistsin providing in-services on CM/InterQual Reviews/UM philosophy, policies, and procedures as needed; coordinates distribution of educational material on CM/InterQual Reviews/UM topics to appropriate hospital personnel.
• Coordinates concurrent review studies performed within the CM/InterQual Reviews/UM Program and prepares resulting reports.
• Manages the Social Services Department.
• Consistently places patient safety as the highest priority.
• ActivelyparticipatesonHospital Committees, asrequired.Assistswith facilitation of the Utilization Management Committee.
• Maintains and reports statistical information on admissions, LOS, etc. Maintains communication and promotes cooperation with other Departments.

Minimum Qualifications

Education

• Bachelor’s degree in Nursing(BSN), Social Work (BSW), Healthcare Administration, or another healthcare-related field from an accredited college or university.

Experience

• Three (3) years of progressively responsible experience in acute care case management,utilizationmanagement, social services, care coordination, or discharge planning in hospital settings.
• Demonstrated knowledge of CMS Conditions of Participation, Joint Commission standards, California Title 22 regulations,utilizationreview, discharge planning, and payer requirements.
• Experience leading both Case Management and Social Services departments.
• Experience with value-based care, population health, denial management, and multidisciplinary care coordination.
• Experience with electronic health records, case management software, and performance improvement initiatives.
• Experience with electronic health records, case management software, and performance improvement initiatives.

Required Licenses & Certifications

Candidates must possessand maintain:

• Registered Nurse (RN) issued by the California Board of Registered Nursing.
• Current Basic Life Support (BLS) certification.
• Valid CA Driver's License may berequiredif travel between facilities is necessary.

Other Skills

• Commitment to patient advocacy, cultural competence, confidentiality, and patient-centered care.
• Ability toestablishand maintain effective working relationships with internal and external stakeholders, including skilled nursing facilities, home health agencies, hospice providers, behavioral health organizations, and community resources.
• Knowledge of quality improvement methodologies, including Lean, Six Sigma, or other performance improvementframeworksis preferred.
• Ability tomaintainconfidentiality and exercise sound judgement in handling sensitivepatient, personnel, and organizational information.

What We're LookingFor

• Exceptional customer serviceand interpersonal skills.
• Professionalism, integrity, and sound judgment.
• Strong verbal andwritten communication skills.
• Strong analytical thinking and the ability to manage multiple tasks concurrently.
• Able to work in, manage and deal with stressful situations.
• The ability toremain calm andmake sound decisionsduring emergencies.
• Effective conflict resolutionand de-escalationskills.
• Strong observation, investigative, and report-writing abilities.
• Computer proficiency, includingsecurity systems andMicrosoft Office applications.

Pay

• Competitive compensationis based on experience, education, certifications, and applicable licensure.

Benefits

(eligibility varies basedon employment status)

We offer a comprehensive benefits package that may include:

• Medical, dental, andvision insurance
• BasicLife and AD&D insurance
• Supplemental life insurance (employee, spouse, and/or child)
• Flexible Spending Accounts(Medical and DependentCare)
• 403(b) retirement planwith employer matchup to 5%
• Paid Time Off(PTO)
• Employee wellness resources
• Professional developmentand training opportunities

At San GorgonioMemorial Hospital,we are committedto creating asafe, respectful, andcompassionate environmentfor our patients, visitors, and oneanother.

If you arelooking for ameaningful career whereyour work hasa direct impacton the healthand safety ofyour community,