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Manager, Outpatient Case Management - Full Time

Company: Prospect Medical Systems - CA
Location: Orange
Posted on: November 22, 2022

Job Description:

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. The Manager, Outpatient Case Management is responsible for the daily oversight and management of Prospect's Outpatient Case Management department including Outpatient supervisors, case managers, care coordinators, and social workers. An in-depth understanding of managed care, Medicare, Medicaid regulations, Model of Care and NCQA requirements are necessary. Other duties include but are not limited to: staff hiring and retention, performance management, reviewing or gathering of data to promote performance improvement, health plan reporting, and participation in or facilitation of meetings or projects related to departmental functions. Job Responsibilities/Duties
Manages outpatient CM areas including organizing and executing Outpatient CM activities aimed to improve delivery of clinical services needs within Prospect Medical Systems, as well as government and regulatory requirements.
Continuously evaluates data outcomes, identifying alternatives, preventing unnecessary costs and services while ensuring quality care, and patient satisfaction.
Performs supervisory audits as necessary to ensure compliance with all external and internal CM requirements and ensures the quality of CM provided to members/beneficiaries.
Assists with the development and implementation of departmental policies and procedures.
Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
Improves on the effectiveness and efficiency of CM staff, through process improvements activities.
Provides leadership and supervision to supervisors, case managers, social workers, and care coordinators.
Participates in onsite and/or web-based health plan audits as scheduled.
Responds to Corrective Action Plan (CAP) as issued by contracted health plans.
Collaborates with the Internal Audit and Compliance Team to ensure Prospect's audit thresholds are met and compliance issues are identified for prompt resolution.
Participates in interdepartmental and cross-functional meetings as needed. Serves as a liaison and resource between Population Health Program and other departments across the organization.
Other duties as assigned by Senior Director.
Qualifications Minimum Education: Bachelor's Degree of Science in Nursing and other related fields or higher preferred. Minimum Experience: Knowledgeable in managed care, Medicare, Medicaid regulations, Model of Care and NCQA Population Health requirements.Two plus (2+) years of Outpatient Case Management or other similar programs experience in managed care required. Strong leadership skills with the ability to influence, manage, and motivate personnel. Must have analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. Ability to prioritize and multi-task. Able to work independently and make independent clinical and non-clinical decisions. Excellent communication skills. Maintain professional attitude when working with internal and external customers. Adeptly utilize programs - both Microsoft Office applications and job-specific electronic software applications. Maintain and ensure confidentiality of patient information. Req. Certification/Licensure: RN unrestricted active license required. 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, benefit eligible positions 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 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: Position Summary Employment Status: Regular Full-time Shift: Days Work Schedule: Monday - Friday Address: Orange 600 City Parkway West, Suite 800

Keywords: Prospect Medical Systems - CA, Orange , Manager, Outpatient Case Management - Full Time, Executive , Orange, California

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