Case Management Manager - Utilization Management

Overview

 

 

Chino Valley Medical Center is a 112-bed community hospital established in 1972 and centrally located in Southern California’s Chino Valley. A nine-time recipient of the Healthgrades Patient Safety Excellence Award (2014-2022), Chino Valley Medical Center has been recognized nationally for its quality, including as among the 100 Great Community Hospitals by Becker’s Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. Chino Valley Medical Center is committed to serving the community’s health care needs with top-rated emergency care as well as senior services, orthopedics, surgical services and more. Learn more at www.cvmc.com.

 

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community!

 

Why Prime Healthcare? Chino Valley Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

 

 

Chino Valley Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs

 

Our Total Rewards package includes, but is not limited to:

• Paid Time Off
• 401K retirement plan
• Outstanding Medical
• Dental
• Vision Coverage
• Tuition Reimbursement
• Many more Voluntary Benefit Options!

Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time.

 

Chino Valley Medical Center is nationally recognized, locally preferred, and community focused.

 

We are an Equal Opportunity 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.  Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

 

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

Responsibilities

The working Manager of Case Management is responsible for the development of staff and systems to effectively operate a comprehensive Case Management Program. Provides leadership and supervision to case managers, social workers, case management coordinators/discharge planners, utilization review coordinators and utilization review technicians. Assesses needs and plans, communicates and designs services that are appropriate to the hospital mission and patient/family needs. Integrates and coordinates services using continuous quality improvement tools. Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

 

1. Licensed clinician in your state. 2. Grandfathered prior to April 1, 2015. Minimum 5 years’ post graduate of an accredited school of Social Work for Licensed Clinical Social Worker.3. Minimum 5 years’ experience in a Case Management position.4. Must have analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process.5. Experience and knowledge in basic to intermediate computer skills.

 

Preferred qualifications:

 

1. Certification in Case Management, BS or BSN or related field preferred.2. Current BCLS certificate preferred.3. Knowledge of Milliman Criteria and InterQual Criteria preferred.

 

Chino Valley Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.  Benefits may vary based on employment status, i.e. full-time, part-time, per die