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.

Qualifications

• Previous management experience required.
• Must have experience in managing high risk cases.
• High level knowledge of Case Management processes and principles
• Prior experience in MSO environment preferred.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 license, CCM certification preferred.

About the Hospital

As one of the largest physician-led networks in Southern California, we have thousands of physicians and hundreds of hospitals committed to providing quality healthcare to all of the communities we serve.

Every day, our employees are inspired to make a difference in the lives of others as well as transform their own experiences to achieve a higher sense of fulfillment. Our employees become a part of an extraordinary team of people dedicated to health, wellness, and happiness for themselves and others. There is no greater reward than contributing to a positive work environment where compassion, understanding, care and attention are encouraged and valued.