Job Description

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Current employees can apply directly through the Internal Careers Center online for Prospect Medical job openings in California. For a streamlined application process, all you need is your four-digit employee ID number and a digital copy of your résumé handy before you apply.

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Director of Case Management (DCM) is accountable for planning, directing and overseeing all aspects of daily operations of the Case Management Department. Ensures standards of operations are in accordance with all state and federal healthcare regulatory guidelines.  Works closely with Physician Advisors and Medical Directors assigned to the Facility(s).  Facilitates the Utilization Management Committee.  Responsible for employee coaching, training, hiring, counseling/discipline, performance assessment and payroll processes. Completes reports and analyzes data as assigned.

• Develops and implements strategic plans, unit/department goals and objectives, business initiatives, and financial plans and budgets.  Complies with all policies/procedures, applicable laws and regulatory agency requirements, and organization work standards. Assumes responsibility for decisions made.  Maintains records in compliance with legal and regulatory requirements. Demonstrates strategic and critical thinking; makes optimal use of resources; allocates and prioritizes work monitoring performance standards for continuous performance improvement.
• Facilitates Utilization Management Committee.  Responsible for planning subject matter and agenda.  Appropriately reviews, revises, and analyzes data prior to meeting.  Ensures that avoidable and variance days are addressed, an action plan is put in place, and goals are set, communicated, and met.  Reviews and distributes minutes to members of UM Committee.
• Collaborates effectively with clinical and administrative leadership, physicians, nurses and a wide variety of other staff to ensure that service expectations and length of stay goals are met. Identifies strategies to improve resource utilization, service delivery, work flow, etc. as necessary to meet established expectations.  Ensures prompt and proper information exchanges and issue resolution. Appropriately informs Vice President of Case Management of issues needing immediate attention.
• Creates a safe work environment that fosters respect and positive morale.  Effectively allocates and evaluates department work, and provides leadership and appropriate follow through to the Department.  Effectively communicates with all staff.  Responsible for hiring, firing, training, annual performance evaluations and competencies, and disciplinary process.

Minimum Education: Active, current, and unencumbered Licensure as a Registered Nurse or Clinical Social Worker in the State of California or Master’s Degree in Business, Health Care Administration or other related field required. Bachelors or Masters of Science in Nursing preferred.

Minimum Experience: Four (4) years of experience in an Acute Care Case Management role required. Excellent verbal and written communication skills. Computer literate. Knowledge of all Federal, State and Local regulatory standards required. Professional demeanor with Healthcare team. Strong Organizational and Time Management skills with ability to effectively prioritize tasks. Demonstrated Leadership Skills. InterQual or MCG criteria knowledge preferred.

Req. Certification/Licensure: Certified Case Manager (CCM) or other Case Management/Nursing Certification preferred.

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

• Company 401K
• Medical, dental, vision insurance
• Paid time-off
• Life insurance

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action 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.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: Case Management, Case Manager, Mgmt, Utilization Review, Leadership, Acute Care