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 Supervisor, Outpatient Case Management has accountability for the direct, daily supervision of case managers’ and coordinators’ work with members, documentation of interventions, and reporting of activities per established protocols. The CM Supervisor maintains visibility to the outpatient CM team and provides “real time” CM guidance and direction as appropriate.Job Responsibilities/Duties* Oversees the process, management, and reporting of Outpatient Case Management activities with focus on health plan compliance and decreasing utilization.* Works with the CM leadership to contribute to the development of CM processes and procedures as needed to ensure process compliance and improvement* Conducts internal audits of case management for Outpatient CM cases, provides feedback and coaching’s to staff as needed* Monitors and evaluates effectiveness of the case management plan and modifies as necessary to meet regulatory requirements to include all required elements. This includes coordinating services, evaluating treatments, intervening in crisis and provide general support.* Hires, trains, coaches, and evaluates the performance of direct reports.* Identify educational needs and provide training and educational resources for current and incoming staff.* Responsible for achieving quality and productivity standards and for ensuring compliance with department policies and procedures* Improves on the effectiveness and efficiency of Outpatient CM staff, through process improvements activities.* Provides leadership and supervision to case managers, and care coordinators.* Participate in Health Network oversight activities, as assigned and required* Maintain knowledge of current regulatory NCQA, CMS, and DMHC requirements and industry trends* Assists with submission deliverables for health plan audits* Oversees internal department meetings (Interdisciplinary care team (ICT) meeting, team huddles, etc.) as applicable.* Other projects and duties as assigned by department Manager and Director.QualificationsMinimum Education: Bachelor’s Degree of Science in Nursing and other related fields or higher preferred.Minimum Experience: Two plus (2+) years of Case management or other similar programs experience in managed care required. Strong leadership skills with the ability to influence, manage, and motivate personnel. Must have analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. Ability to prioritize and multi-task. Able to work independently and make independent clinical and non-clinical decisions. Excellent communication skills. Maintain professional attitude when working with internal and external customers. Adeptly utilize computer programs – both Microsoft Office applications and job-specific electronic software applications. Maintain and ensure confidentiality of patient information. 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: RN unrestricted active license required. Will consider LVN with supervisory experience in managed care. Knowledgeable in managed care, Medicare, Medicaid regulations, Model of Care and Case Management requirements.Employee Value PropositionProspect 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 insuranceHow to ApplyTo apply for this role, or search our other openings, please visit 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:
Associated topics: business development, case manager, development, liaison, manage, office manager, plan, program development, program management, project development

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