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Job Details

Manager of Care Management

San Jose, CA

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Job Description
Under direction to manage and coordinate the patient care services for care management, discharge planning and utilization review program as required under federal and state regulations and Santa Clara Valley Medical Center's Utilization Management Plan.
Learn more about Santa Clara Valley Medical Center: Hospital and Clinics at  **** and follow us on:
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Typical Tasks
Plans, organizes, and schedules staff to ensure appropriate staffing and caseload distribution to achieve goals of the utilization management plan and safe and timely hospital discharges;
Coordinates care management services with Nurse Managers to facilitate admissions through expedited patient discharges and patient flow through all phases of hospital care;
Directs, evaluates and develops systems and procedures for efficient and effective operations for discharge planning, care management and utilization management;
Implements defined quality improvement and utilization management programs including but not limited to ensuring data collection, analysis of data, evaluation of outcomes and report generation;
Supervises, orients, directs, evaluates and is responsible for the training of subordinate staff;
Assesses staff competency and identifies the educational needs of staff as well as the quality of care management services delivered related to expected length of stay standards;
Coordinates and ensures daily interdisciplinary care team meetings occur to facilitate discharge planning activities on every inpatient care unit;
Communicates with staff and reports findings related to compliance with standards for care planning, discharge planning, utilization review, and related standards and regulations;
Recommends and ensures implementation of corrective action plans for care management and utilization management to achieve planned quality improvements in patient care services;
Collaborates with physicians, nurses and other clinical positions to identify opportunities to improve functions related to care management and evaluate the impact of improvement activities;
Attends daily bed management and nursing meetings as required;
Serves as an expert resource and advisor regarding expected length of stay for a targeted diagnosis related group;
Optimizes utilization of the online care management program;
Participates as a member of the Nurse Manager leadership group;
Represents the care management division as assigned and as needed to provide expertise regarding care management and utilization management functions;
May be assigned as a Disaster Service Worker, as required;
Performs other related duties as assigned and required.
Employment Standards
Possession of a license as a Registered Nurse issued by the California Board of Registered Nursing upon appointment.
The required skills, knowledge and abilities would be acquired through possession of a Bachelor's degree in Nursing or a related field or possession of a Master's degree in Nursing Administration and a Bachelor's degree in Public Administration, Business Administration, or Health Care Administration;
Three (3) years of professional experience in utilization review and/or case management or nursing management in a complex hospital setting of which a minimum of two (2) years has been in an administrative or supervisory capacity.
A Master's degree in Nursing may be substituted for one year of required experience.
Knowledge of:
Hospital organization, operations for emergency and acute care;
Principles and practices of nursing and patient care services for care management, discharge planning, and utilization management in an acute health care setting;
Federal and state health care laws and regulations common to the operation of hospitals in California;
Regulations of intermediary agencies pertaining to hospital stay coverage (e.g. Medicare/Medi-Cal);
Principles and applications of a hospital information system(s) as it relates to care management and utilization review;
Principles and practices of supervision, staff development, organization, administration, fiscal and program management;
Criteria for level of care (i.e. InterQual ®) and current standards in medical and nursing practice;
Ability to:
Act as a resource to physicians, nurses and care management staff;
Analyze, interpret, apply and implement state and federal rules and regulations;
Evaluate data and statistics and prepare reports;
Select, train, supervise, develop, evaluate and motivate staff;
Work effectively as a member of a management team in a large health care organization;
Communicate effectively both orally and in writing.
Closing Date/Time: 8/21/2018 11:59 PM Pacific

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