Lead Case Manager

$105,726 - $134,077/Yr

ScionHealth - Ontario, CA

Full-time

Ontario, CA

Hospitals

About the position

The Case Management Team Leader provides leadership and operational oversight for case management and utilization management activities in a Kindred hospital. This role involves coordinating patient care, collaborating with interdisciplinary teams, and ensuring compliance with healthcare regulations. The leader serves as a subject matter expert and mentor, enhancing patient management quality and satisfaction while advocating for patients and families throughout the care continuum.

Responsibilities

• Provide leadership for the case management team and oversee daily operations.
• Coordinate and facilitate patient care through collaboration with the Interdisciplinary Care Transitions (ICT) members.
• Serve as a subject matter expert, mentor, and preceptor to staff, providing education on resource utilization and discharge planning.
• Monitor patient care to ensure optimum resource utilization and compliance with external review agencies.
• Conduct comprehensive assessments and care planning for individual patient needs.
• Enhance patient management quality and satisfaction to promote continuity of care and cost-effectiveness.
• Partner with external customers, referral sources, and payors to facilitate discharge planning.
• Accountable for the facility's denial management program.
• Participate in interdisciplinary patient care rounds and conferences to review treatment goals and optimize resource utilization.

Requirements

• Graduate of an accredited program required; BSN preferred.
• Master of Social Work with licensure as required by state regulations.
• Bachelor of Social Work with licensure as required by state regulations.
• Healthcare professional licensure required as Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations.
• Certification in Case Management preferred.
• Two years of experience in a healthcare setting preferred, preferably in acute or LTACH.
• Prior experience in Case Management, Utilization Review, or Discharge planning is preferred.

Nice-to-haves

• Knowledge of government and non-government payor practices, regulations, standards, and reimbursement.
• Knowledge of Medicare benefits and insurance processes and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Ability to demonstrate critical thinking, appropriate prioritization, and time management skills.