Job Description

Reporting to the Senior Director of Case Management, this position is directly responsible for managing the daily operations of inpatient case management across Regal Medical Group. The Manager, Inpatient Case Management is responsible for oversight of inpatient review, concurrent review and discharge planning of inpatient cases for all members assigned to this region. Responsible for the development of concurrent review and discharge planning training and quality review programs that maximize quality while utilizing appropriate resources within the members’ benefit plans and established contracts. The Manager will also be responsible for cooperation and problem solving with network management, finance, and claims department. The manager is expected to work in collaboration with other medical management departments to ensure optimal clinical outcomes, appropriate resource utilization, quality patient care, and high enrollee satisfaction.

The manager will participate in process improvement measures such as standardized documentation and auditing, programs that maximize quality, and programs to ensure appropriate resource utilization within members benefit plan and established contract.

The Manager, Inpatient Case Management is responsible, along with other members of Medical Management Team, for contributing to the clinical, quality, financial and patient satisfaction outcomes of Regal Medical Group.

Essential Duties and Responsibilities include the following:

• Manages inpatient nurse case managers and ensures optimal staff performance.
• Performs facility visits to mentor, evaluate and assist Regal Inpatient Case Managers stationed in regional hospitals.
• Identifies and implements policies and procedures that incorporate best practices and ensure effective inpatient concurrent reviews.
• Assists in overseeing compliance and consistency of the program that meets RMG and regulatory standards.
• Develop and maintains effective working relationships with hospital case management departments to optimize collaboration and facilitate timely reviews.
• Develops and implements training plans for new and existing staff.
• Acts as a resource for clinical staff for case review and discharge planning.
• Develops, monitors, and analyzes reports and identifies trends to develop programs and processes that improve program outcomes.
• Participates in developing and coordinating strategies across the continuum of care for ensuring the delivery of care in the most cost effective setting.
• Works with the Medical Directors on a daily basis to review inpatient hospitalizations with inpatient staff for level of care and discharge planning, including review of face sheets and assuming a nurse leadership role with rounds. Will assist with cases in need of complex discharge planning.
• Maintains on-call schedule and participates in on-call process as needed for training and monitoring of nurses.
• Develops annual department goals and objectives focused on improving patient outcomes and department efficiency.
• Maintains quality monitors as determined by the Utilization Management and Quality Management Committees and RMG Management.
• Responsible for orientation, instruction/training of new personnel.
• Works collaboratively with the entire Medical Management team to ensure compliance with regulatory and health plan requirements.
• Oversees “triage” of patients to the appropriate level of care and facility, and acts as a resource to other concurrent review nurses in the transfer process.
• Works closely with other departments (claims, finance, high risk, TOC) as needed.
• Anticipate our customer needs: Understand the wants and needs of customers, listen for cues and identify how to respond and what level of intervention they need.
• Maintains high level of professionalism and cultural competency when working with members and hospital staff.
• Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
• Demonstrates honesty and integrity in everyday activities.
• Protects privacy for both patients and employees; ensures information sensitive papers, charts, and reports are not in view of the public.
• Recognizes when an error has been made and immediately reports to appropriate manager.
• Participates in “service recovery” through follow-up with an upset customer, gathering information, and demonstrates empathy.
• Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families. Functions as liaison between administration, patients, physicians, and other healthcare providers.
• Interacts professionally with patient/family/providers and involve patient/family/providers as appropriate.
• Communicates appropriately and clearly to management, co-workers, and physicians.
• Understands and applies principles of adult learning methods as they relate to health care educational needs.
• Consults other departments as appropriate to provide for an interdisciplinary approach to the patients’ needs.
• Pursues additional education (in-services, seminars, self-study, and formal education programs) to advance nursing skills and knowledge.
• Documents appropriately pertinent information completely, in the authorization system according to nursing standards and policies.
• Participates in the efficient, effective, and responsible use of resources such as supplies and
• Performs all other duties as directed by 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.

Qualifications

Education and/or Experience:

• Requires California RN license, BSN preferred.
• Requires current CA driver’s license and car insurance
• Previous management experience necessary.
• High level knowledge of Concurrent Review/Case Management processes and principles
• Prior experience in MSO environment preferred.
• Ability to work with all levels of management.
• Must have excellent communications skills both verbally and written.
• Must have excellent organizational skills.
• Prior experience with project development and implementation preferred.
• Required to travel for new client implementation.
• Must have demonstrated knowledge of MS Office environment, and EZ Cap