Position Type : Full Time - Permanent
Relocation Approved :
Recruiter : Rowley, Rachel
Job Description :
Location: Creekside Center, Stockton, CA
*RN with MDS/Medicare/Medicaid Knowledge. Would supervise 1 PT RN.
POSITION SUMMARY: Responsible for the administrative and financial oversight of the region’s center-based care management staff. This position oversees the personnel and processes necessary to ensure that the region’s network of owned and managed centers is effectively managing resource utilization, improving clinical outcomes, maximizing reimbursement, complying with contractual obligations and responding to the needs of its payor customers.
1. Develops, implements and maintains a center-based care management model which meets the clinical and financial goals of Genesis and the operational expectations of Genesis’ payor customers
2. Establishes standards of performance for care management staff and ensures they are met
3. Hires, supervises, monitors and evaluates assigned staff
4. Identifies staff training needs related to managed care contracts and collaborates with appropriate Genesis personnel to develop the educational tools and materials that are needed to achieve care management goals.
5. Identifies business development opportunities which result (or may result) from improved center specific clinical and administrative capabilities and communicates them to the Regional Director
6. Develops systems which measure the utilization of services in the region’s centers, identify opportunities for improvement, provide feedback to regional management and interface with regional financial and clinical outcomes systems
7. In collaboration with the region’s senior clinical management staff, develops a formal procedure for effectively addressing concurrent and retrospective clinical and administrative denials by payors
8. Acts as resource to staff for questions or issues 9. Maintains budgetary responsibility for department
1. Registered nurse or another clinical certification acceptable to the Director, Business Development and the region’s senior clinical management team
2. Strong communication skills with the ability to be a trouble shooter
3. Advanced word processing and spreadsheeting skills
4. Five years care management experience, including at least 2 years overseeing patient insured by a managed care organization and 2 years significant management experience
1. Demonstrates excellent communication skills, oral and written
2. Demonstrates strong interpersonal skills
3. Demonstrates ability to work in a fast paced, high pressure environment
4. Demonstrates ability to prioritize, organize, trouble-shoot, and problem solve
5. Demonstrates a sound understanding of customer service principles and practices