Senior Manager, Clinical Care Coordination

Care Navigators On Demand; Newhall (IA); On-site; USD 90,000 - 120,000; Full time

Job summary

Care Navigators On Demand in Newhall, CA, seeks an experienced Nurse Case Manager to lead clinical care coordination, utilization management, discharge planning, and outcomes management within an acute care setting.

You will oversee MediCal TAR processes, ensure regulatory compliance, develop workflows, and mentor care teams while working with patients, families, clinicians, and health plans.

Qualifications

• Knowledge of the theory, principles, and practices of case management and social services.
• Knowledge of patient rights.
• Knowledge of management and supervision including planning, organizing, directing, motivating, controlling and decision making.
• Ability to communicate effectively with individuals at all levels and from all backgrounds both orally and written.
• Ability to set priorities appropriately and handle multiple issues concurrently.
• Ability to establish and monitor departmental and corporate goals.
• Ability to motivate subordinates to work effectively and efficiently.
• Strong critical thinking skills with the ability to work independently as well as in teams.

Responsibilities

• Provides leadership and management of clinical carecoordination, utilization management, discharge planning, and outcomesmanagement.
• Oversees the MediCal TAR process...
• Manages the systems, processes, and outcomes ofclinical care teams and programs designed to address clinical andfinancial needs of patients and families.
• Responsible for goal setting, program planning, workflow processes, regulatory compliance, staff productivity, facilitation ofwork teams, quality of work, outcome evaluation and continuous qualityimprovement.
• Represents the hospital to internal and externalcustomers, including patients and families, physicians, service lineleadership, administration, and health plans.
• Maintains professional and collaborative relationshipswith the hospital administration, staff, physicians, service lineadministration, other internal and external customers, including healthplans, medical groups, patients and families.
• Develops and maintains a positive working relationshipwith the Physician Advisor of the facility to ensure correct patientclassifications, timely denials management, and development ofcollaboration with physician members and other departmental leaders withinthe hospital.
• Participates in Utilization Review Committee functions.
• Knowledge of State and Federal Regulations includingbut not limited to EMTALA, MediCal, Medicare, and HMO’s.
• Contributes toward effective, positive workingrelationships with internal and external colleagues.
• Demonstrates cooperation, flexibility, reliability anddependability in all daily work activities.
• Demonstrates a willingness to collaborate with othersfor the good of the customer and the organization.

Skills

Leadership

Communication

Prioritization

Critical thinking

Collaboration

Education

Baccalaureate in Nursing

Master’s degree preferred

Tools

McKesson InterQual

Job description

Care Navigators On Demand in Newhall, CA, seeks an experienced Nurse Case Manager to lead clinical care coordination, utilization management, discharge planning, and outcomes management within an acute care setting.

You will oversee MediCal TAR processes, ensure regulatory compliance, develop workflows, and mentor care teams while working with patients, families, clinicians, and health plans.