Manager, SNF Case Management

The Manager of SNF Case Management is responsible for actively participating in the review process of pre-service requests for services, and to follow guidelines in the approval of those services or in making recommendations for other determinations to the provider/vendor (denial/modification/redirection). The goal of the Manager of SNF Case Management will support the other medical directors of the UM team by collaborating in processes and procedures, while working with the team to deliver excellent care in a cost-effective manner based on medical management referral processing guidelines. The Manage of SNF Case Management will be detail-oriented and able to research and successfully evaluate often-complex clinical information to help formulate decisions and communication with members, providers and internal users. Additionally, the Manager of SNF Case Management will work with medical management and network management teams to establish, develop, and maintain IPA provider relations via in-person meetings, formal and informal provider education, communication, and delivery of management services.

Essential Duties and Responsibilities include the following:

• Manages and monitors Enrollees assigned to High Risk (Vital Care) case management programs to ensure efficient and timely delivery of care, timely referrals, and moving the Enrollee's treatment plans through the care continuum.
• Develops, monitors, and analyzes Program and Department reports and identifies trends to improve clinical and utilization and quality outcomes.
• Collaborates with the RMG Medical Directors to analyze data and implement programs that will improve Enrollee outcomes.
• Develop a standardized process for triaging and enrollment of appropriate members into High Risk (Vital Care) case management programs for RMG.
• Identifies and develops Program and Department policies and procedures and ensures compliance and consistency throughout RMG regional sites.
• Develops and coordinates Program and Department strategies for ensuring the delivery of care in the most cost effective setting.
• Act as a resource for hospitalists, SNFs, outpatient utilization management staff, home health care agencies, Employer home-visit physicians and nurse practitioners.
• Motivates, instructs, mentors, audits and leads and constantly improves the quality of service and clinical outcomes rendered by the Employer's the High Risk (Vital Care) Case Management staff.
• Develops annual Program and Department goals and objectives focused on improving patient outcomes and efficiency.
• Implements tools and processes that direct and role model a high level of customer service behavior toward Enrollees.
• Works collaboratively with the entire Medical Management team to ensure that Employer company goals as well as compliance with regulatory and health plan requirements are met.
• Has direct oversight responsibility and accountability of the Program and Department case management and ancillary staff.
• Has oversight of Vital Care Clinics.
• Training, mentoring, auditing of the clinical competency, productivity, contribution, customer service interaction of Program and Department professional and non professional staff. Act as a resource to all staff members of the Program and Department.
• Manager shall be based in the Northridge site.
• Provide regular audit reports on Program and Department staff and action plans to improve efficiency and efficacy.
• Assume on call responsibilities to support and act as a resource to Program and Department staff, and ensure the timely response to urgent/emergent Enrollee needs
• Directly report to Vice President of Utilization Management.
• Manager's service area jurisdiction and responsibilities may be expanded and/or changed at Employer's discretion and in consultation with the Vice President of Utilization Management,
• Other responsibilities to be determined by mutual agreement in consultation with the Vice President of Utilization Management.

The pay range for this position at commencement of employment is expected to be between $120,000 - $130,000 annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Education and / or Experience:

• Previous management experience required.
• Must have experience in managing high risk cases.
• Experience with SNF Case Management.
• High level knowledge of Case Management processes and principles
• Prior experience in managed care environment preferred.
• Must have excellent verbal and written communications skills.
• Must have excellent organizational skills.
• Must have prior experience with project/program development and implementation.
• Must have working knowledge of MS Office environment
• Requires current CA driver's license and car insurance
• Requires active CA RN license, CCM certification preferred.