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.
Supervisor (Clinical) of Outpatient Case Management is responsible to directly support the Clinical Manager in over all management and oversight of Regal Outpatient Care Management Programs. The role will develop, implement and provide program oversight of Department projects and comply the program contractual agreements. Supervisor (Clinical) develop strategies to implement and evaluate program effectiveness. Ensure that the Department is in compliance to Case Management Model of Care and Quality Regulatory Requirements. Provide supervision, coaching, monitors staff productivity and timely care coordination of enrollees designated at high risk for progression of disease, clinical decline, and in need of urgent or emergent care.
Will support the Clinical Manager of the daily operations of the Program and Department and for operational partnership with concurrent review team managing inpatient and SNF admissions, home health care services, home visit program staff, hospice agencies, and preauthorization department. Cooperation and problem solving with Network Management, Finance, and Claims is also expected.
Responsible for processes to oversee ambulatory case management including standardized documentation and auditing, programs that maximize quality, programs to ensure appropriate resource utilization within members benefit plan and established contracts.
Supervisor (Clinical) is responsible to work in collaboration with other Medical Management Departments to ensure optimal clinical outcomes, appropriate resource utilization, quality patient care, and high enrollee satisfaction.
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Supervises staff, manages and monitors Enrollees assigned to Outpatient 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 Outpatient Case Management programs for RMG North.
* 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 Outpatient 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 in RMG North.
* 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.
* Supervisor shall be based in the Northridge site.
* Provide regular audit reports on Program and Department staff and action plans to improve efficiency and efficacy.
* Supervisor's service area jurisdiction and responsibilities may be expanded and/or changed at Employer's discretion and in consultation with the Vice President of Clinical Operations,
* Other responsibilities to be determined by mutual agreement in consultation with the Vice President of Clinical Operations.
Qualifications:
* 3 years of previous supervisory and management experience required.
* Must have experience in managing high risk cases.
* High level knowledge of Case Management processes and principles
* 2 years of prior experience in MSO/Medical Group/Health Plan setting required.
* Ability to work with all levels of management.
* Must have excellent verbal and written communications skills.
* Must have excellent organizational skills.
* Must have prior experience with project development and implementation.
* Must have working knowledge of MS Office environment
* Requires current CA driver's license and car insurance
* Requires active CA RN/LVN license, CCM certification preferred
We offer a full benefits package which includes employer paid medical, pharmacy and dental benefits. We offer a generous PTO package, 401k Retirement Savings, Life Insurance, Flexible Spending Account (FSA), Tuition Reimbursement & Licensed Renewal Fees for our clinical staff.