What are the responsibilities and job description for the Manager, Care Coordination - Utilization Review/Utilization Management - Full-time (1.0 FTE), 8-hr. Days position at Stanford Health Care?

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Day - 08 Hour (United States of America)

Why work at Stanford Medicine | Stanford Health Care (SHC)?

Recognized as a top Academic Medical Center globally!
Ranked No. 10 on the Best Hospitals Honor Roll by 2022-2023 U.S. News and World Report.
Ranked the No. 3 hospital in California and No. 1 in San Jose metro area!

Stanford Clinicians are recognized as bold leaders, compassionate healers, educators, and mentors, providing the highest standards of excellence in care while generating long-term impressions that continue to set SHC apart as the best place to work and thrive. We offer a wide array of career advancement opportunities, and access to the latest technologies and healthcare innovations, and boast a workplace culture that encourages personal growth and work-life balance while honoring its commitment to delivering evidence-based and patient-centered care.

We are seeking a results-driven manager to further develop the framework for clinical, operational, and leadership practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team.

Are you driven by health care innovation, partnerships, and measurable results to improve the continuity of care and lessen readmissions? Then, join us and make SHC your career home.

Our core benefits include medical insurance, dental insurance, vision insurance, an employee assistance program, savings and spending accounts, disability, life and accident insurance, and COBRA. For medical insurance, you have the choice of three generous health plans through Stanford Health Care Alliance, Aetna, or Kaiser Permanente. Each plan includes 100% coverage for preventive care, telemedicine through Teledoc, prescription drug coverage, and behavioral health coverage. Additional incentives exist for healthy choices. And so much more - generous leave & time off, Wellness Program, special programs, educational assistance, and adoption assistance.

This is an onsite Stanford Health Care job.

A Brief Overview

This role independently supervises a multidisciplinary team including case managers, social workers, complex care managers and support liaisons. The position is responsible for providing exemplary oversight and maintaining relationships with service lines and departments related to the provision of care coordination services to Stanford Hospital and Clinics. This position provides clinical and administrative supervision for a multidisciplinary staff, hiring, employee evaluations, and program development for the Department of Social Work and Case Management. Additionally, this position serves as a resource for problem solving, budgeting, performance improvement, policy implementation and staff issues. Responsibility for the interpretation of data related to social work and case management and delivery of interventions is a key part of this role.

Locations

Stanford Health Care (Palo Alto, CA; onsite)

What you will do

Continuously assesses and improves care coordination teams' and the department's performance based on patient needs; directs and participates in improving performance and services which benefit staff, patients and other patients. Maintains appropriate quality improvement programs in response to staff and patient feedback, internal standards of care and external requirements. Evaluates and implements changes based on data related to productivity, quality and outcomes for departmental projects and programs.

Collaborates with other departments, managers and physicians to continuously improve care coordination and integrates services within the department and the hospital.

Develops and implements policies that guide and support the provision of services in line with the mission and goals of SHC; ensures that policies and procedures meet both internal and the external regulatory and statutory requirements. Ensures compliance with State Mandated Reporting Policies and Procedures.

Support the integration of the department's services with the hospital's primary functions by supporting organizational mission, priorities and goals, and by delivering optimal quality health care services.

Maintains an openness to change and fosters that attitude with peers, staff, physicians, and committee members. Maintains a focus on both the operational details and larger strategic vision in order to effectively move toward completion and positive outcomes.

Determines necessary levels of and provides supervision of operational and clinical functions of staff. Ensures that a sufficient number of qualified and competent persons are available to provide care that is safe and service oriented. Has responsibility for selection, orientation, coaching, supervision, development and evaluation of care coordination staff.

Acts as a steward of departmental and hospital resources, responsible for ensuring we remain within budget for staffing; participates in budgeting discussions and decisions. Oversees service line efficiencies to ensure appropriate utilization of Health System resources including patient financial assistance.

Collaborates with Patient Access Services and Patient Billing Services to guarantee appropriate reimbursement to organization and control for financial risk.

Monitors and controls for risk management concerns for individual cases.

Assumes responsibility for department in absence of Director.

Takes regular 24 hour Administrator-on-Call responsibilities on a rotating basis with other managers when on-call Supervisor is unavailable.

Develops and oversees relationships and referral processes between Health System and post-hospitalization service providers (Home Health Agencies, Extended Care Facilities, Durable Medical Equipment vendors) in collaboration with Contract Management and Legal Affairs.

Assists Director in designing, implementing, and maintaining efficient systems and processes which promote departmental efficiency, productivity, and assure compliance with regulatory standards.

Education Qualifications

Master's degree in relevant field.

Experience Qualifications

Five (5) years of progressively responsible and directly related work experience.

Required Knowledge, Skills and Abilities

Knowledge of principles and best practices of case management, utilization review, social work, care coordination and discharge planning.

Knowledge of managed care and commercial insurance, Medi-Cal, Medicare, and other third-party reimbursement.

Knowledge of principles and practices of organization, administration, fiscal and personnel management.

Ability to ensures staff are compliant with applicable standards and requirements of external professional, regulatory and accrediting agencies / bodies for social work, case management, discharge planning, and continuum of care through policy and procedure development, implementation, and monitoring.

Ability to develop and retain a multidisciplinary staff within the department. Helps all employees enhance and maximize skills.

Ability to drive a culture of proactive, integrated, high quality patient care, innovation, transformation, and change within the department.

Ability to quickly learn new tools and theories in process improvement / change management.

Ability to communicate effectively, demonstrating excellent verbal and written communication skills.

Ability to implement departmental standards, systems, staffing plan and processes.

Ability to analyze complex issues and problem solve in a proactive, creative manner, using sound judgment based on factual information and clinical knowledge to create an effective plan to address them.

Licenses and Certifications

Nursing / RN - Registered Nurse - State Licensure and / or Compact State Licensure or

LCSW - Licensed Medical Social Worker - State Licensure 180-days of starting the position

These principles apply to ALL employees :

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford's patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family's perspective :

Know Me : Anticipate my needs and status to deliver effective care

Show Me the Way : Guide and prompt my actions to arrive at better outcomes and better health

Coordinate for Me : Own the complexity of my care through coordination.

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and / or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale : Generally starting at $86.41 - $114.50 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

Salary : $86 - $115

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Manager, Care Coordination - Utilization Review/Utilization Management - Full-time (1.0 FTE), 8-hr. Days

What are the responsibilities and job description for the Manager, Care Coordination - Utilization Review/Utilization Management - Full-time (1.0 FTE), 8-hr. Days position at Stanford Health Care?

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