Manager, Case Management

Company: Stanford Children's Health - Lucile Packard Childr
Location: Pleasanton
Posted on: March 20, 2025

Job Description:

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• You must use your legal name as it appears in AccessHR.Job DescriptionJOB SUMMARYPlans, organizes, manages, evaluates and provides overall administration, direction, and management of the staff and day-to-day activities of Case Management/Utilization Review, one of two major organizational components (the other being Social Work Services) within the hospital. The Case Management Manager acts as a consultant to the clinical team, service lines and other departments, and participates in program development and quality improvement initiatives. A hospital-based Case Management system has as its primary goal to ensure the most appropriate use of services by patients and, toward that end, to avoid duplication and misuse of medical services, control costs by reducing inefficient services, and improve the effectiveness of care delivery. Objectives are to facilitate timely discharge; prompt, efficient use of resources; achievement of expected outcomes; collaborative practice; coordination of care across the continuum; and performance/quality improvement activities that lead to optimal patient outcomes.ESSENTIAL FUNCTIONSThe essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.Must perform all duties and responsibilities in accordance with the hospital's policies and procedures, including its Service Standards and its Code of Conduct.* Advises the Director on the various needs of the Case Management and Utilization Review function, such as staffing needs, supplies, equipment, space and other resources needed to meet patient and staff needs. Recommends and participates in selecting outside sources for needed services. Develops and maintains an effective system of information, records and reports for assigned department(s) utilizing appropriate manual or electronic systems.* Continuously assesses and improves department's performance based on "customer" needs; manages and participates in improving performance and services which benefit staff, patients and other customers. Determines fiscal requirements and assists in budget preparation for department. Monitors, verifies and reconciles expenditure of budgeted funds, including the preparation of monthly variance reports.* Effectively maintains appropriate quality improvement and control programs in response to staff and patient feedback, internal standards of care and external requirements. Evaluates and implements changes based on data related to productivity, quality and outcomes for departmental projects and programs.* In collaboration with the Director, plans, develops, implements and promotes a comprehensive program of Case Management and utilization review activities for the hospital and clinics, including identification of Case Management issues and development of strategies, policies, and procedures for Case Management interventions; ensures that policies and procedures are compatible with the function and goals of LPCHS and which meet the external, regulatory and statutory requirements.* Leads and participates in program planning, identifying Case Management and utilization review needs, and resolving problems. Organizes activities with other departments/units to ensure efficient coordination of services.* Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs.* Plans, coordinates and conducts staff meetings to ensure compliance with established practices and regulatory requirements, to implement new policies, and provide communication to staff.* Provides leadership and management to licensed nursing professionals providing Case Management and utilization review services and support staff. Recruits, interviews, hires, orients, and promotes staff. Responsible for the systematic evaluation of staff performance. Ensures personnel policies and procedures are followed and monitored. Initiates corrective/disciplinary action and responds to grievances. Provides consultation, mentoring, and clinical supervision to Case Management staff. Advises and confers with case managers on unusual or difficult cases. Assigns, schedules, and reviews the work of Case Management staff to ensure adequate coverage.* Provides leadership and participates primarily in intradepartmental program planning, task forces, committees and performance improvement initiatives. Provides expertise and direction to staff for complex problem solving.* Provides teaching to staff to enhance clinical knowledge, maintain licensure and other areas. Ensures there are adequate ongoing education programs and training opportunities for staff with his/her area of responsibility, including orientation of new employees and relevant in-service education sessions.* Reviews and analyzes data and reports related to the provision of Case Management services.KNOWLEDGEThese are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education or licensure/certification.* Ability to make effective oral presentations and prepare concise written reports to a variety of audiences Ability to monitor and assure the patient's access to the appropriate level of care; the right health care providers; and the correct setting and services to meet the patient's needs; promote coordination and continuity in patient health care.* Ability to provide appropriate patient care and clinical information when patients are admitted, referred, transferred, or discharged.* Knowledge of applicable hospital policies, rules and regulations; requirements and standards of external accrediting and regulatory organizations; statutory requirements, including HIPAA; contemporary medical issues and health trends.* Knowledge of available patient services and treatment.* Knowledge of current theories, principles, practices, standards, emerging technologies, techniques and approaches in the nursing profession, and the health care system, and the responsibility and accountability for the outcome of practice.* Knowledge of financial processes of various private and public funding sources for health care services/procedures.* Knowledge of medical terminology and related levels of care and treatment.* Knowledge of principles and practices of organization, administration, fiscal and personnel management Knowledge of the full continuum of care available to patients, interrelationships of the care components, and their effective integration.* Knowledge of the models of case management, including the principles and practices of discharge planning, utilization review, and quality assurance/improvement.* Knowledge of the variables that affect the processes and outcomes of patient health care.PHYSICAL REQUIREMENTSThe Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job.QualificationsMINIMUM QUALIFICATIONSAny combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.* Education: Bachelor's Degree in Nursing from an accredited college or university.* Experience: Five (5) years of progressively responsible and directly related work experience.License/Certification:
  • Registered Nurse by California Board of Registered NursingAdditional InformationPay RangeCompensation is based on the level and requirements of the role. Salary within our ranges may also be determined by your education, experience, knowledge, skills, location, and abilities, as required by the role, as well as internal equity and alignment with market data. Typically, new team members join at the minimum to mid salary range. Minimum to Midpoint Range (Hourly): $90.76 to $111.90Stanford Medicine Children's Health (SMCH) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SMCH does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements, and where applicable, in compliance with the San Francisco Fair Chance Ordinance.
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Keywords: Stanford Children's Health - Lucile Packard Childr, Pleasanton , Manager, Case Management, Executive , Pleasanton, California