Providence St. Joseph Health

Job Information

St. Joseph Health / Covenant Health Manager, Care Management in Apple Valley, California

We are looking for a Mgr, Care Management at St. Mary Medical Center.

Location: Apple Valley, CA

Work Schedule: Full time - 80 Biweekly hours

Shift: 8 hour Days

Job Summary:

Provides an optimal practice environment that ensures the delivery of quality patient care. Responsible for planning, directing and managing the nursing care delivered to a designated patient population on one or more nursing units. Oversees the operation of the patient care unit with accountability for leadership, budget preparation and overall fiscal management, staffing, planning, organizing and controlling. Role models proactive, collaborative working relationships across all hospital functions in an interdisciplinary approach to patient care. Develops programs, policies, procedures, and standards of care to ensure patient's nursing care needs are assessed, evaluated, and met.

Essential Functions:

  • Assists in the process components of Care Management, in conjunction with the multidisciplinary team.

  • Assists in the development of the written Care Management Program description that outlines the program structure, goals and objectives of the program, the organizational structure that supports the program and the specific care management projects designated for the year.

  • Assists in the re-assessment and re-evaluation of the goals and objectives identified in the care management program on an annual basis. Oversees the development of policies & procedures through identification and / or revision.

  • Participates as a member of various committees to ensure that actions and issues are consistent with the care management program goals and objectives.

  • Employs benchmark criteria Milliman / InterQual medical necessity and appropriateness of stay, placement, and discharge. Assures inter-rater consistency.

  • Assists in the timely and accurate concurrent and retroactive review for health plans. Meets standards for delegated UR functions. Assures regulatory compliance in determining denial of service and / or providing notices on non-coverage. Supports and monitors denials and the appeal process. Coordinates this process with Patient Financial Services.

  • Monitors and tracks variant / avoidable bed days/visits and other utilization trends. Reports data as required to appropriate entities. Assists in implementing corrective actions as deemed appropriate.

  • Assists with establishing care management goals in collaboration with the Physician Advisor, clinical service chiefs, and administration.

  • Assists in creating and monitoring systems and methodologies to ensure appropriate care manager coverage for all patient populations. Ensures all patients are screened for care management.

  • Ensures treatment plans are monitored and that the appropriate level of care and length of stay is provided and that discharge planning is facilitated. This forum supports the mechanism for care management staff to discuss and problem-solve care management issues and specific patient cases experiencing delays in treatment or discharge.

Skills :

  • Excellent oral and written communication skills.

  • Preferred: Bilingual English/Spanish.

Minimum Position Qualifications:

Education :

  • Bachelor's Degree in Nursing.

  • Coursework/Training - Training in Case Management, Clinical and Management.

Experience :

  • 3 years of Experience in an acute care hospital.

  • 3 years of Hospital based or Insurance based Care Management experience.

Licenses and Certifications:

  • Current California RN license by evidence of Primary Source Verification R00020.

  • BLS certification B00010.

Preferred Position Qualifications:

License/Certification : CCM certification.

St. Mary Medical Center (SMMC) is an acute care hospital with 213 beds and over 1,750 employees making it one of the region's largest employers serving communities of the High Desert. The facility was constructed in 1956 and joined the St. Joseph Health System in 1992.This facility has the only Neonatal Care Unit in the High Desert Accredited by California Children Services and has been granted approval as a Special Hospital with the California Children's Services Community Neonatal Intensive Care Unit. St. Mary was accredited as a primary Stroke Receiving Center in 2018, the only stroke-receiving center in the High Desert.The Services and Clinical Specialties offered at this Hospital are Diabetes Education, Emergency Services, Heart and Vascular Services, Imaging Services, Rehabilitation Services, Respiratory Services, Robotic Surgery Services, Surgical Services, Women & Children's Services and Wound Care and Hyperbaric Medicine.

Company: St. Mary Medical Center

Category: Clinical Lead Supervisor/ Manager