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Manager of UR/Case Management in Norwalk at Los Angeles Community Hospital

Date Posted: 6/21/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    13222 Bloomfield Avenue
    Norwalk
  • Experience:
    Not Specified
  • Date Posted:
    6/21/2018
  • Job ID:
    8612

Job Description



Manager of UR/Case Management

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

As the Manager for CM, over sees the daily operations of the assigned caseload. Ensures Medical Necessity for pt admission and concurrent stay at the short term acute hospital level of care are met, utilizing the facility approved non MD reviewer guidelines.



Job Responsibilities/Duties

  • Responsible for hiring and evaluating CM staff.
  • Ensures a safe and timely discharge / transition to the next appropriate level of  care.
  • Ensures timely escalation of unresolved care coordination issues to the appropriate level.
  • Oversees the PI functions of the department.
  • Enters delays in service and avoidable days regarding exceeded payer LOS variances.
  • Ensures  timely escalation of unresolved care coordination issues to the appropriate level.
  • Communicates denials and physician related utilization management practices to immediate supervisor same day as identified.
  • Keeps Facility Administration and VP of Case Management aware of any daily operational / physician related issues.
  • Works  closely with the facility Physician Advisor and Corporate CMO (Chief Medical Officer).
  • Maintains effective working relationships with payers, physicians, providers and Business Development.
  • Works collaboratively with health care team,  patients and families, administration and members of the Medical Staff.
  • Responsible for active participation in daily weekday intra disciplinary patient rounding.
  • Is a resource to the CM Team.
  • Supports the initiatives of the company.


Qualifications

Minimum Education: RN required. BSN or equivalent preferred.

Minimum Experience: Education,training, and experience consistent with caring for patients of all age groups. Minimum three (3) years clinical experience in an acute care hospital. Prefer two years of experience in utilization management in a short term acute care facility and / or managed care setting. Knowledge of diagnosis-related groups (MS-DRGs & APR DRGs).  Knowledge of JCAHO and / or DNV Standards and Title XXII regulations. Knowledge of CMS, MCARE, MEDICAL and Managed Care reimbursement. Knowledge of InterQuaL and / or Milliman Care Criteria.

Req. Certification/Licensure: Current California R.N. License / LVN License. Nationally recognized Case Management Certification preferred.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance


How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: Manager of UR/Case Management.