Job Details
Job Location
Corporate Headquarters - Chula Vista, CA
Salary Range
$102,154.94 - $122,585.93 Salary/year
Description
POSITION SUMMARY
Provides supervision to the Clinical Case Managers in Community Health Group's (CHG's) High Risk Case Management program, and is responsible for the optimal and timely delivery of proactive and collaborative case management and care coordination activities.
COMPLIANCE WITH REGULATIONS
Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D, DHCS and DHMC.
RESPONSIBILITIES

• Supervises staff in day-to-day functions, including training and developing the case management and care coordination staff to accomplish program goals and objectives.
• Assists in the development, maintenance, and implementation of metrics to appraise the productivity and quality of staff performance.
• Supervises the management and care coordination of identified high risk members to reduce recurrent and unnecessary hospital admissions, readmissions, and emergency room visits.
• Works in close collaboration with Interdisciplinary Care Team and contracted physician groups who conduct assessments to establish members care needs.
• Supervises the process to promote smooth transitions of care for targeted members.
• Coordinates individually needed interventions for select members based upon CHG established indicators.
• Provides guidance to case managers and care coordinators with difficult cases and situations; assumes responsibility of cases when risk management issues are identified.
• With the Health Care Services management team, works to develop, implement, and evaluate interventions designed to enhance member outcomes, quality metrics, and increase customer satisfaction.
• Functions as a resource to internal and external customers.

Qualifications
EDUCATION

• Graduate from an accredited school of nursing or other clinical related field required
• BA degree in health related field preferred
• Certification in case management preferred.

EXPERIENCE/SKILLS

• 2 years' experience as a high risk case manager and 1-year experience in a managed care environment, hospital discharge planning or outpatient clinic is required.
• 1 year of supervisory experience preferred.
• Knowledge of population health, care/case management clinical operations, and management expertise relating to business planning, process improvement, budget administration, and personnel management.
• Working knowledge of Microsoft programs; proficiency with Word and Excel.
• Knowledge of managed care principles, CPT, ICD-10, HCPCS coding, experience with inpatient and outpatient medical review guidelines (MCG).
• Familiar with Medi-Cal, Medicare. Familiar with Web based standard of care sites i.e. NIH, ACOG.
• Ability to communicate effectively verbally and in writing; exceptional telephone and customer service skills; ability to establish effective working relationships with physicians and medical professionals;
• May be required to conduct in-person visits and assessment of members.

OTHER REQUIREMENTS

• Prolonged periods of sitting at desk; intermittent standing, walking and bending.
• May be necessary to work and attend meetings outside of facility or normal business hours.
• Lifting 10 lb. or less.
• Driving within County of San Diego
• California driver's license in good standing.

**Must have current authorization to work in the USA**
Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and trainings. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.