Director of Case Management/Utilization Review/Social Services - FT/Days
San Gorgonio Memorial Hospital - California

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Director of Case Management/Utilization Review/Social Services - FT/Days Job Description Functions as a working Supervisor of Case Management. Provides an effective case management program focused on client assessment, proactive identification of needs, effective discharge planning and efficient and effective resource management. Provides appropriate referral for identified needs, and multi-disciplinary planning to meet such needs for a safe appropriate level of discharge planning. Assists with core measure compliance in a concurrent manner. Assists with the development of clinical management tools such as clinical pathways, algorithms, and standing order sets to facilitate the efficient and effective use of resources. Maintain Safety Goals with our patients and families by a conscious effort to comply with the National Safety Goals. Provide Quality of Care for our patients and families by performing a Best Practice Act for our patients and families. Assumes a leadership/supervisory role by assisting with the daily operations/functions of the department including scheduling, complete Interqual reviews and fax to reimbursement sources, staff assignments, orientation of new staff members, completion of Treatment Authorization Request (TAR) forms and identification of/assisting with staff education needs. Takes the lead in job counseling and performance evaluation. Coordinates communication of information from outside entities to staff. Functions as the Medi-Cal Managed Care liaison. Functions as Central Business Office liaison. Collaborates with Central Business Office Manager to investigate insurance denials. Collaborates in writing appeal as applicable. Develops and maintains Case management policies and procedures. Coordination with outside agencies including but not limited to CPS/APS and psychiatric services. Coordinator of Riverside County 5150 training and certification process for all SGMH designated 5150 evaluators. Clinical duties: Screenings and assessments of patients to facilitate optimal discharge, APS/CPS reporting, grief work and supportive therapy with patient and family regarding end-of-life decisions and critical illness, functions as a resource and referral service to patients and families.

Qualifications BSN in Nursing and required on-going education in your field. Prefer: Certified as Case Manager. Completed at least five years in Case Management position in an acute care setting. Previous experience managing a case management program desired. Knowledge of Interqual system for means of reimbursement and Basic Computer Skills. Knowledge and experience with Medi-Cal. Excellent communication skills and ability to work with others. Familiarity with psychiatric presentations, mental health services including 5150 criteria. Knowledge of local community resources and procedures for access.

Company Overview San Gorgonio Memorial Hospital’s is a 71-bed, non-profit community hospital, with a dedicated team of highly qualified professional staff. We are looking for enthusiastic, energetic, and dedicated health care professionals who want to become a part of our team as we grow to meet the needs of our ever growing community. Take advantage of our competitive salaries and excellent benefit package and see why working at SGMH is the right move to make. Come grow with us!