Organizational Description

The Community Health Center Network (CHCN) is a partnership between eight health service organizations in Alameda County, whose mission is to provide a comprehensive range of professional health care in a manner respectful of the community values and traditions. CHCN is a nonprofit corporation, serving as an agent for its member health service organizations.

Position Title:Basic Case Management UM Nurse Supervisor

Department:Care Management

Reports To:Utilization Management Director

Classification: Exempt

Status :Full-Time Regular

Salary Range: $100,200 to $132,700 yearly

Candidate must be willing to have primary residence in California. For licensing and tax purposes, we are unable to hire candidates residing outside of the state of California starting on the date of hire.

POSITION SUMMARY

The Basic Case Management UM Supervisor will serve as the lead on the Basic Case Management team. Members of this department proactively coordinate and assist with the transition of medically-complex patients from one setting to another (hospital, home, and SNF). The Basic Case Management UM Supervisor will assist with outpatient Coordination of Care (CoC) and Care Coordination (CC) for members. The Basic Case Management UM Supervisor works collaboratively with medical and clinical staff from varied settings including, but not limited to; hospitals, primary care offices, ambulatory care, and home care. Case Managers assess and reassess members for program participation, and develop, implement and update CC/COC plans for each member. Case managers communicate with members telephonically and in writing as necessary. They assist members in linking to care across the spectrum of care – primary care, hospital care, and home-based care.

ESSENTIAL POSITION RESULTS

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain and/or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may perform other duties as assigned.

• Ability and desire to advocate for patients and help them achieve their best health.

• Strong empathic communication skills to support members who are in need of services and may be in distress. Must understand and support members from various different backgrounds and experiences.

• Knowledge of local health care landscape and resources available for members.

• Proactively and collaboratively interface with clinics, health plans, physicians, internal staff, members and members’ families to assist in expediting appropriate discharge and linkage to primary care services.

• Refer members to various other departments (Provider Services, Eligibility, and Complex Case Management at the health plan level) for follow-up as appropriate.

• Work with the Utilization Management Director as well as In-Patient and Out-patient Supervisors to improves processes across the UM Department.

• Support hospital discharge planning, transfers, provide education regarding member benefits, and authorize post-discharge care, equipment, and services as medically necessary.

• Identify barriers to efficient hospital utilization and facilitate resolution.

• Serve as a liaison between the hospital, health plan, vendors, and providers and health centers.

• Serve as a liaison with other departments within CHCN (In-patient and Out-patient UM, Provider Services, Compliance) to best serve member needs.Meet departmental review and documentation standards for work assignment.

• Train new members of the department on department work flows and expectations.

• Serve as a resource to direct reports and enhance their development.

• Build and maintain appropriate relationships on behalf of CHCN

• Support a positive work environment and foster teamwork.

• Create and manage team schedules.

• Help to resolve employee issues and disputes.

• Responsible for providing performance evaluation and feedback, and creating corrective action plans when needed.

• Responsible for the day-to-day supervision of the Basic Case Management team.

• Help to maintain cost effective program operation; provide necessary reports, statistics, and other requested information to the UM Director, stakeholders and other agencies.

• Responsible for internal audits on client files to ensure case management plans identified needs, are up-to-date, and that data quality is maintained.

HIPAA Designated Access

“For the purposes of the job duties of this position, the person in this position requires access only to the following HIPAA protected information data sets”

1. MSO Membership2. MSO Claims3. MSO Referral/Auth4. MSO Capitation

5. Data Warehouse6. Chart Audit/QI7. Disease Registry

SUPERVISORY RESPONSIBILITIES

Yes

MINIMUM QUALIFICATIONS

Competencies

• Competent leadership and administrative skills.

• Good communication and customer relations’ skills; ability to work well with a team and independently.

• Utilization Management and Case Management experience, understanding and knowledge of healthcare benefits associated with various business lines (Medi-Cal, Medicare, and Commercial).

• Outpatient Review, especially working with complex medical patients, including aged, blind, disabled.

• Ability to work independently in most instances, requiring limited supervision.

• Proficiency in computer operations, navigational skills and comfortable with Internet-based applications.

• Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.

• Professional demeanor.

Essential Requirements

• Active, unrestricted, California Nursing License (Registered Nurse)

• Minimum three years of medical clinical nursing experience

• Minimum one year of UM/CM experience in hospital, HMO, or IPA setting.

• Excellent communication, organizational and time management skills with the ability to meet tight timeframes.

• Strong understanding of the managed care environment.

• Ability to work effectively and collaboratively with a variety of customers including hospital/office staff, health plans, members and physicians.

• Flexible and adaptable to change.

• Ability to learn quickly and retain complex information.

• Travel to work assignments, appropriate individual automobile insurance must be maintained.

General CHCN roles

• Fosters an environment that promotes trust and cooperation among clients, clinical care team, and CHCN staff.

• Enforces policies and procedures, including maintenance of client confidentiality, to ensure that the principles of CHCN are implemented.

• Accountable for participating in decision-making processes and understanding the outcome(s).

• Understands the values and principles of CHCN and applies them in work responsibilities.

• Participates in Case Management meetings as well as outreach activities, agency advocacy, and serves on ad hoc committees, as requested.

CERTIFICATES AND/OR LICENSES

RN, active without limitations/restrictions

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to talk or hear. The employee is frequently required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.

WORKING CONDITIONS AND ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly exposed to both an inside/outside environment.

The Community Health Center Network is an Equal Opportunity Employer.