Manager, Outpatient Case Management

Summary of position:

• Manager of Outpatient Case Management is responsible for management and oversight of Regal Outpatient Care Management Programs.  The Program and Department coordinate and manage care of enrollees designated at high risk for progression of disease, clinical decline, and in need of urgent or emergent care. 
• Directly responsible for 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.
• Manager 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.

Essential Duties and Responsibilities include the following:

• 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.
• Manager shall be based in the Northridge site.
• Provide regular audit reports on Program and Department staff and action plans to improve efficiency and efficacy.
• Manager’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.
• All other duties as directed by management.

The pay range for this position at commencement of employment is expected to be between $110,000 - $125,000 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 comp