Supervisor, Complex Case Management (CCM) 

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.

This position has accountability for facilitating person-centered, safe, efficient, and effective care transitions for all Prospect members following discharge from a hospital or Skilled Nursing Facility (SNF).  

Job Responsibilities/Duties

• Oversees the process, management and reporting of Complex Case Management (CCM) and Whole Child Model (WCM) activities.
• Responsible for achieving quality and productivity standards and for ensuring compliance with department policies and procedures.
• Works with the Manager of Outpatient Case Management to review and revise job aids to ensure process compliance and improvement.
• Conducts internal audits of case management for CCM, and WCM 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.
• Oversees internal department meetings (Interdisciplinary care team (ICT) meeting, team huddles, etc.) as applicable.
• Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
• Provides guidance and trainings to CM’s to ensure regulatory compliance.
• Improves on the effectiveness and efficiency of CCM and WCM 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.
• Other projects and duties as assigned by department Manager and Director.

Qualifications

Minimum 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. Knowledge of HIPAA regulations preferred. Excellent written and verbal communication skills (50 WPM). Exceptional customer service and conflict resolution skills. Must be able to work independently. Ability to multi-task, prioritize, and work in a fast pace environment. Must be proficient in Microsoft Office navigation, Excel, Outlook, Teams and Word and/or IDX knowledge.  Knowledgeable in managed care, Medicare, Medicaid regulations, Model of Care and NCQA Complex Case Management requirements.

Req. Certification/Licensure: RN unrestricted active license required. 

Employee Value Proposition

Prospect 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 insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ 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: https://www.eeoc.gov/