Director - Outpatient Case Management

Company: Prospect Medical Health California
Location: Orange
Posted on: February 4, 2019

Job Description:

Manages the overall budget for case management for the California market Oversees CM position control and hiring of new staff Directs and optimizes the development and implementation of evidence-based, best practice CM processes and interventions Establishes and evaluates CM productivity metrics; reviews CM ratios (by health plan/product) routinely and directs caseload rebalancing as needed Contributes to the clinical, quality, financial, and member/beneficiary and provider satisfaction outcomes for the California market. Acts as a resource to other departments across the organization regarding case management, and special considerations of frailty and high chronic condition burden. Directs the development and maintenance of a repository of CM requirements from all CA contracted health plans and products or lines of business Provides oversight of case management compliance with all external and internal CM requirements and ensures the quality of CM provided to members/beneficiaries Collaborates with the Internal Audit Team to ensure CM case audit thresholds are met and compliance issues are identified for prompt resolution Responsible for meeting and exceeding Compliance Requirements , conducting Root Cause Analysis, and Corrective Action Plans. Qualifications Minimum Education Bachelors Degree. Minimum Experience Five to ten (5-10)years of hands on outpatient case management experience. Two to three (2-3) years' experience in a director or above role within a medical management organization. Req. Certification/Licensure Registered Nurse or BSN required, with extensive case management and senior leadership experience.

Keywords: Prospect Medical Health California, Orange , Director - Outpatient Case Management, Executive , Orange, California