Case Management Supervisor (CASE MGT HC SUPV 2)

Valid California Registered Nurse License without restrictionBachelor's degree in Nursing (BSN)5 years clinical experience in an acute care hospital with 2 years in Discharge Planning and/or Utilization Management. 2 years experience in a leadership or supervisory role in a healthcare organization or system. Complete working knowledge of, and skill to apply practices, principles, and techniques of patient care, authorization needs, as pertaining to areas of responsibilities.Knowledge of Medicare, MediCal, Insurances, and HMO legislation, third party payor contracts, Title XXII, JCAHO, and CMS criteria. Demonstrated knowledge of how these programs/regulations effect the functions and role of the department; ability to incorporate them into departmental systems/processes.Knowledge of the Nurse Practice Act and/or National Association of Social Workers Standards for Social Work Practice and the responsibilities related to coordination of discharge planning services across the continuum. Knowledge of Case Management Society of America’s Standards of Professional Case Management Practice and/or American Case Management Association’s Standards of Practice and Scope of Services.Knowledge of evidence-based screening tool to assess for medical necessity in the acute setting.Knowledge and comprehension of federal, state, and licensure regulations, including Title XXII, JCAHO, and EMTALA guidelines. Demonstrated knowledge of how these regulations affect the functions and role of the department; ability to incorporate them into departmental systems/processes. Broad based clinical skills, enabling a broad area of assessment, planning, and intervention as it relates to overall responsibilities.Ability to read and comprehend English text and medical terminology; knowledge of medical and nursing treatment plans, levels of care and Health System resources to effectively perform departmental responsibilities and act as a resource to physicians and staff; skill in assessing the appropriateness of medical admissions and continued stay.Skill to perform in-depth analysis of medical records and other documents to determine accurate information in a concise, informative manner, and to identify/analyze problems or issues related to areas of responsibility. Ability to organize and direct varied health care team professionals in a manner that establishes a good rapport and professional working relationship.Leadership skills to work as part of a team, collaborate with colleagues, and direct others to accomplish tasks in a positive manner, which are conducive to positive operations within the department, maintain a positive rapport with peers and staff, and motivate cooperation of staff while working toward institutional and departmental goals.Ability to work efficiently and independently in a calm manner, under pressure with a positive customer-service oriented manner during periods of peak workload, with frequent interruptions, under tight deadlines, and when interacting with challenging customers who may be frustrated and/or angry.Ability to organize work to accommodate patient needs, health system goals and objectives, as well as special projects, deadlines, and priorities.Decision-making skills to independently exercise delegated authority to take action, and to recognize when it is appropriate to seek assistance from others when limits of delegated authority have been reached.Verbal communication skills to effectively communicate in person and by telephone with administrative, medical, clinical, technical, and clerical staff to clearly and concisely receive, elicit, and convey information of a medical, financial, or administrative nature within and outside the university.Public speaking skills to effectively address large groups through committee or community group speaking engagements to explain and respond to department functions. Written communication skills to clearly and concisely compose letters, reports, policies, and procedures which could include medical, financial, and administrative information.