Manager, Outpatient Clinical Programs in Orange at Prospect Medical Systems

Date Posted: 11/14/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    600 City Parkway West
    Orange
  • Experience:
    Not Specified
  • Date Posted:
    11/14/2019
  • Job ID:
    13574

Job Description



Manager, Outpatient Clinical Programs

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 Manager of Outpatient Clinical Programs is responsible for the daily oversight and management of Prospect’s Outpatient Case Management department including Outpatient supervisors, case managers, care coordinators, and social workers. An in-depth understanding of managed care, Medicare, Medicaid regulations, Model of Care and NCQA requirements are necessary. Other duties include but are not limited to: staff hiring and retention, performance management, reviewing or gathering of data to promote performance improvement, health plan reporting, and participation in or facilitation of meetings or projects related to departmental functions.



Job Responsibilities/Duties

  • Manages outpatient CM areas including organizing and executing Outpatient CM activities aimed to improve delivery of clinical services needs within Prospect Medical Systems, as well as government and regulatory requirements. Continuously evaluates data outcomes, identifying alternatives, preventing unnecessary costs and services while ensuring quality care, and patient satisfaction. Performs supervisory audits as necessary to ensure compliance with all external and internal CM requirements and ensures the quality of CM provided to members/beneficiaries. Assists with the development and implementation of departmental policies and procedures.
  • Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
  • Improves on the effectiveness and efficiency of case management staff, through process improvements.
  • Provides leadership and supervision to case managers, social workers and case management coordinators.
  • Oversees all Health Plan reporting completions and submissions in a timely manner. Participates in onsite and/or web-based health plan audits as scheduled. Responds to Corrective Action Plan (CAP) as issued by contracted health plans. Collaborates with the Internal Audit and Compliance Team to ensure CM case audit thresholds are met and compliance issues are identified for prompt resolution.
  • Participates in interdepartmental and cross-functional meetings as needed. Serves as a liaison and resource between case management and other departments across the organization.
  • Other duties as assigned by Senior Director.


Qualifications

Minimum Education: None.

Minimum Experience: Three plus (3+) years of case management experience in managed care required. Three plus (3+) years demonstrated leadership and team management/development skills preferred. Experience in health plan audits and compliance is a plus.

Req. Certification/Licensure: LVN/RN unrestricted active license required.



Employee Value Proposition

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 you will receive:

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

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.



How to Apply

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: Acute Care



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