Company Info

NorthBay Healthcare

4500 Business Center Drive
Fairfield, CA, United States

Phone: 707-646-3322
Web Site: www.northbay.org

Company Profile


Director, Case Management


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Category:

Case Management Director-VP

Title:

Director, Case Management

Location:

Fairfield, CA, United States 

Zip Code:

94534
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Employment Type:

Full time

Salary:

Competitive per year

# of Beds:

150
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Job Requirements:

Education:

  1. Graduate from an accredited school of registered nursing. Bachelor’s Degree in Nursing or related Health Care field is required. 
  2. Master’s Degree in Nursing or related Health Care field is required or required to be in progress.  One of the degrees must be in nursing.

Licensure and Certification:

  1. Current and unencumbered California Registered Nursing License required.
  2. National Certification in Case Management preferred. Certification must be obtained within 2 years of hire. 

Experience, Knowledge, and Skills:

  1. Three to five years experience in Care Management. 
  2. Three to five years of demonstrated progressive management experience with increasing scope of responsibility. 
  3. Demonstrated initiative, follow through and ability to work independently.
  4. Demonstrated results oriented management
  5. Demonstrated effective project management skills.
  6. Experience with MIDAS and Interqual/MCG preferred.
  7. Knowledge of CMSA scope of practice
  8. Knowledge of CDPH, CMS conditions of participation, and Title XXII.
  9. The NorthBay Way is a set of value-based behaviors that are to be consistently demonstrated and role modeled by all employees that work at NorthBay Healthcare. The NorthBay Way principles consist of Caring, Communication, Collaboration, and Competence. 
  10. Excellent written and verbal communication and presentation skills.
  11. Must be able to deal with job-related stress, multiple projects and deadlines. 
  12.  Advanced computer skills (spreadsheets, graphs, tables and reports).

Job Description:

Job Summary:
  1. Oversees a staff of Case Managers (inpatient and outpatient), Resource Specialists, Appointment Specialist, and RN Auditor who are all responsible for patient care coordination.
  2. Develop and implement case management and disease management programs based on population needs.
  3. Evaluates patient care data to ensure that care is provided in accordance with clinical guidelines and organizational standards. Seeks treatments that balance clinical and financial concerns with the family's needs and the patient's quality of life.
  4. Contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care.
  5. Executes and implements policies, processes and procedures in support of these programs and is capable of resolving escalated issues arising from operations and requiring coordination with other departments.
  6. Responsible for program development, documentation compliance, and compliance with health plan (reducing outbound referrals effectively and efficiently managing covered lives to improve outcomes) and other regulatory requirements including the Medicare Conditions of Participation.
  7. Provides operational direction to support the strategic plan as provided by the AVP of Care Management. S/he identifies key measures of success (e.g. length of stay and readmission rates), and implements key processes to maximize efficient resource utilization.
  8. Assumes overall responsibility for coordinating/managing patient centered care activities, and ensures cost effective, quality patient outcomes through the supervision of clinical/professional staff, and collaboration with medical staff, nursing, and support staff. 
  9. Ensures compliance with state/federal and other regulatory and accreditation body requirements.

Job ID:

36271