Job description

The Manager of Case Management (or Case Management Manager) performs highly responsible management work in leading, developing, directing, and coordinating programs and functional activities for post-discharge/Welcome Home and case management teams for all lines of business including Medicare, Medi-Cal, HMO, and PPO.

This person ensures corporate utilization management goals around readmissions and ER visits are met through member care coordination initiatives and identifies and oversees implementation of process changes as needed to meet these goals.

Job Responsibilities

• Provide case management direction to the functional areas of welcome home and complex case management to achieve annual department, corporate and ICE goals
• Provide oversight to supervisors carrying out staff responsibilities; interpret policies, operational procedures, and department objectives
• Collaborate with the Care Management Advisor responsible for annual review, modifications, and submission of the Case Management Program Description
• Oversee Case Management and Welcome Home staff and manage relevant care coordination strategies: production TAT’s, welcome home program, video visits uptake, medication reconciliations post-discharge, provider follow-up appointments scheduled within 7 days, and enrollment of highest risk members in complex case management
• Provide direction and support to staff to promote good decision-making in areas of responsibility, utilizing information analysis of factors related to Hill Physician’s goals of admissions, readmissions, ER and other strategies
• In collaboration with the department's Senior Director, applies Human Resources/Personnel policies according to organizational procedures and serves as a resource for the implementation of such policies and procedures; defines expectations for performance and holds subordinates accountable; sets goals and outcome parameters and defines operational parameters and expectations
• Interviews, hires, and conducts performance evaluations for each of the positions directly accountable to the position; acts as a resource to department supervisors in completion of performance evaluations
• In collaboration with the department Director, participate in the organization’s budget planning process; organizes the budget planning process in assigned area of responsibility; monitors and analyzes budget variances
• Assists Regional and Corporate Medical Director functions
• Serve as a resource for physicians, providers, members, and staff; participates on assigned committees; promotes effective communication; acts as liaison to other departments, medical staff, and health plans to facilitate information-sharing, collaborative problem solving, and adequate provision of support services
• Assures that department functions are integrated appropriately into company operations
• Collects, analyzes, evaluates, and presents clinical management data to internal and external leadership; perform operations analysis with appropriate follow-up action plan and intervention.
• Establishes planning processes in response to corporate strategy, goals, and objectives; monitor progress and accomplishments on a regular basis; promotes and coordinates case management initiatives and program development through appropriate planning, analysis, and developmental phases
• Reviews department performance in relation to established goals; implements changes to effect continual improvement in services provided; and ensures compliance with regulatory and legal requirements
• Supervises the administration of Medical Management Teams and supports organization clinical initiatives
• Represents Case Management Department on inter-departmental committees

Required Experience

• Active unrestricted CA RN license
• Minimum of five years management experience, ideally with at least two years in a managed care environment
• Excellent leadership, organizational, communication and presentation skills
• Self-motivated with the ability to work independently

Required Education

• Bachelor’s degree in nursing or health related field; Master’s degree preferred
• Case Management certification (CCM) strongly preferred

Salary Range

$140,000 - $155,000+

Please note that this position will have bonus earning potential and offers a full suite of benefits including 401k matching.

At Hill Physicians Medical Group, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Additional Information

We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and one of the “Healthiest Places to Work in the Bay Area.” We have an award-winning Wellness Program, and our average tenure is ~8 years. Every person who joins Hill Physicians is coming in as a leader and has the very real potential to grow with the company as we grow. We’re all in it for the long haul and are bought-in to the success and future of our organization.

We’re proud to have been (and continue to be) a pillar of the Northern Californian healthcare community for more than 30 years. Our more than 5,000 primary care physicians and specialists provide high-quality care across the San Francisco Bay, Sacramento, and Central Valley areas.

By adapting to both the demands of the industry and the needs of consumers, we’ve remained stable and profitable, and our service area now ranges from the Pacific Ocean to the Sierra Nevada’s. We’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Our culture is guided by core values​ that promote the health and wellness of our employees and communities (health), commitment (accountability), fiscal responsibility (stewardship), teamwork (collaboration), and our dedication to do the right thing (integrity). 97% of employees feel that supervisors and managers “walk the talk”​ and demonstrate our core values. Join us!

Hill Physicians is an Equal Opportunity Employer

Job Type: Full-time

Pay: $140,000.00 - $155,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Medical specialties:

• Home Health
• Medical-Surgical
• Surgery

Schedule:

• 8 hour shift
• Monday to Friday

Supplemental pay types:

• Bonus pay

Ability to commute/relocate:

• Sacramento, CA 95821: Reliably commute or planning to relocate before starting work (Required)

Education:

• Bachelor's (Required)

Experience:

• Case management: 5 years (Required)
• Management: 3 years (Required)
• Supervising: 3 years (Required)
• Auditing: 3 years (Preferred)
• Process improvement: 3 years (Preferred)
• Managed care: 3 years (Required)
• Medicare: 3 years (Required)

License/Certification:

• RN (Required)
• Certified Case Manager (Preferred)

Work Location: Hybrid remote in Sacramento, CA 95821

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