(RN) Manager, Care Management - La Jolla - 134319

UC San Diego Health is a Magnet designated organization, which is a prestigious recognition that applies to only 10% of all U.S. hospitals. Magnet is the "gold standard" for nursing excellence and is based on strengths in five key areas, which include transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovation and improvements and empirical outcomes. UC San Diego Health has held its Magnet status since 2011.

The Manager of Care Management is responsible and accountable for providing administrative and clinical leadership for the Care Management Department. Develops standard work flows of care management that demonstrates success in: promoting high quality, cost effective delivery of care; ensuring effective utilization of resources across the continuum; excellent customer service; and compliance with regulatory and internal UCSD requirements. Spearheads innovative projects and approaches involving multi-disciplinary factions for systems improvement that affects patient outcomes and length of stay across the organization. Plans, schedules and organizes work for department ensuring proper distribution of assignments and efficient utilization of personnel, space and facilities.

The Manager of Care Management supervises staff, screens candidates, interviews and hires new employees. Ensures staff competence, compliance with staff licensure/certification requirements and maintenance of related documentation. Conducts performance appraisals, counsels staff, and takes disciplinary action as required in consultation with Human Resources/Labor Relations. Ensures compliance with discipline-related action plans.

Key Responsibilities:

• Manages the staff responsible for case management to include all or most of the following: utilization management, discharge planning, social work services, denial management, and patient throughput.
• Implements operational processes that contribute to effective and efficient workflow coordination among physicians, clinicians, and other patient care and support staff, from across the medical center.
• Works with Information Technology managers to promote and support care coordination and case management review interests in organization-wide IT initiatives, including electronic medical records, revenue management, patient finance, and business intelligence.
• Evaluates effectiveness of case management interventions based on analysis of Line of Duty (LOD) care, readmissions, staff and patient satisfaction, and financial indicators.
• Works with members of the interdisciplinary team to support the continuous improvement of expedited patient care delivery, throughput processes and transitions across the continuum. - - * Recommends quality improvement measures and plans.
• Participates on organization wide committees to facilitate integration of the case management into patient care delivery models.
• Works with colleagues across the medical center to ensure compliance with accreditation and licensure requirements within the clinical services environment, including JCAHO, CMS, and State of California.
• Responsible for employee recruitment, performance evaluation and management, and staff development and training.
• Develops a strong culture of teamwork to ensure the quality of daily operations, effective interdepartmental collaborations, and the timely achievement of objectives.
• Keeps abreast of best practice research to identify and propose opportunities to improve both patient quality of care and the financial outcomes for the medical center.
• Other duties as assigned.

• Bachelor's degree in nursing or other healthcare profession, and seven (7 ) or more years of relevant experience in clinical case management; or equivalent combination of experience, education and training.

• Registered Nurse (RN) license issued by the State of California.

• Current Case Management certification (CCM, ACM), or must obtain within 12 months of hire.

• Experience and proven success in hospital management skills, with progressive expertise in case management, utilization review, discharge planning, home care and/or managed care.

• Strong analytical and critical thinking skills.

• Interpersonal skills and ability to effectively communicate on an individual level and within large groups. Strong written and communication skills. Strong presentation skills.

• Ability to mentor and train other leaders.

• Must have decision making, problem solving and prioritizing skills.

• Master's degree in nursing.

• Two (2 ) or more years of Case Management leadership experience in a tertiary or quaternary healthcare environment.

• Working knowledge of Milliman Care Guidelines or InterQual.

• Current Lean Six Sigma Green Belt or higher, or willing to complete within 24 months of hire.

• Must be able to work various hours and locations based on business needs.
  
• Employment is subject to a criminal background check and pre-employment physical.