Manager, Inpatient Case Management
Company: Regal Medical Group, Inc.
Location: San Bernardino
Posted on: November 20, 2023
Area of Interest Utilization/Quality Management Position Type
Full-time Job Description Position Summary:Reporting to the Senior
Director of Case Management, this position is directly responsible
for managing the daily operations of inpatient case management
across Regal North. The Manager, Inpatient Case Management is
responsible for oversight of inpatient review, concurrent review
and discharge planning of inpatient cases for all members assigned
to this region. Responsible for the development of concurrent
review and discharge planning training and quality review programs
that maximize quality while utilizing appropriate resources within
the members' benefit plans and established contracts. The Manager
will also be responsible for cooperation and problem solving with
network management, finance, and claims department. The manager is
expected to work in collaboration with other medical management
departments to ensure optimal clinical outcomes, appropriate
resource utilization, quality patient care, and high enrollee
satisfaction.The manager will participate in process improvement
measures such as standardized documentation and auditing, programs
that maximize quality, and programs to ensure appropriate resource
utilization within members benefit plan and established
contract.The Manager, Inpatient Case Management is responsible,
along with other members of Medical Management Team, for
contributing to the clinical, quality, financial and patient
satisfaction outcomes of Regal Medical Group.Essential Duties and
Responsibilities include the following:
- Manages inpatient nurse case managers and ensures optimal staff
- Performs facility visits to mentor, evaluate and assist Regal
Inpatient Case Managers stationed in North region hospitals.
- Identifies and implements policies and procedures that
incorporate best practices and ensure effective inpatient
- Assists in overseeing compliance and consistency of the program
that meets RMG and regulatory standards.
- Develop and maintains effective working relationships with
hospital case management departments to optimize collaboration and
facilitate timely reviews.
- Develops and implements training plans for new and existing
- Acts as a resource for clinical staff for case review and
- Develops, monitors, and analyzes reports and identifies trends
to develop programs and processes that improve program
- Participates in developing and coordinating strategies across
the continuum of care for ensuring the delivery of care in the most
cost effective setting.
- Works with the Medical Directors on a daily basis to review
inpatient hospitalizations with inpatient staff for level of care
and discharge planning, including review of face sheets and
assuming a nurse leadership role with rounds. Will assist with
cases in need of complex discharge planning.
- Maintains on-call schedule and participates in on-call process
as needed for training and monitoring of nurses.
- Develops annual department goals and objectives focused on
improving patient outcomes and department efficiency.
- Maintains quality monitors as determined by the Utilization
Management and Quality Management Committees and RMG
- Responsible for orientation, instruction/training of new
- Works collaboratively with the entire Medical Management team
to ensure compliance with regulatory and health plan
- Oversees "triage" of patients to the appropriate level of care
and facility, and acts as a resource to other concurrent review
nurses in the transfer process.
- Works closely with other departments (claims, finance, high
risk, TOC) as needed.
- Anticipate our customer needs: Understand the wants and needs
of customers, listen for cues and identify how to respond and what
level of intervention they need.
- Maintains high level of professionalism and cultural competency
when working with members and hospital staff.
- Demonstrates the ability to follow through with requests,
sharing of critical information, and getting back to individuals in
a timely manner.
- Demonstrates honesty and integrity in everyday activities.
- Protects privacy for both patients and employees; ensures
information sensitive papers, charts, and reports are not in view
of the public.
- Recognizes when an error has been made and immediately reports
to appropriate manager.
- Participates in "service recovery" through follow-up with an
upset customer, gathering information, and demonstrates
- Treats patients and their families with respect and dignity.
Identifies and addresses psychosocial, cultural, ethnic, and
religious/spiritual needs of patients and their families. Functions
as liaison between administration, patients, physicians, and other
- Interacts professionally with patient/family/providers and
involve patient/family/providers as appropriate.
- Communicates appropriately and clearly to management,
co-workers, and physicians.
- Understands and applies principles of adult learning methods as
they relate to health care educational needs.
- Consults other departments as appropriate to provide for an
interdisciplinary approach to the patients' needs.
- Pursues additional education (in-services, seminars, self
study, formal education programs) to advance nursing skills and
- Documents appropriately pertinent information completely, in
the in the auth system according to nursing standards and
- Participates in the efficient, effective, and responsible use
of resources such as supplies and
- All other duties as directed by management.The pay range for
this position at commencement of employment is expected to be
between $120,000 - $130,000 annually; however, base pay offered may
vary depending on multiple individualized factors, including market
location, job-related knowledge, licensure, skills, and
experience.The total compensation package for this position may
also include other elements, including a sign-on bonus and
discretionary awards in addition to a full range of medical,
financial, and/or other benefits (including 401(k) eligibility and
various paid time off benefits, such as vacation, sick time, and
parental leave), dependent on the position offered.Details of
participation in these benefit plans will be provided if an
employee receives an offer of employment.If hired, employee will be
in an "at-will position" and the Company reserves the right to
modify base salary (as well as any other discretionary payment or
compensation program) at any time, including for reasons related to
individual performance, Company or individual department/team
performance, and market factors.As one of the fastest growing
Independent Physician Associations in Southern California, Regal
Medical Group, Lakeside Community Healthcare & Affiliated Doctors
of Orange County, offers a fast-paced, exciting, welcoming and
supportive work environment. Opportunities abound, and
enterprising, capable, focused people prosper with us. We promote
teamwork, nurture learning, and encourage advancement for all of
our employees. We want to see you excel, because we believe that
your success is our success.Full Time Position Benefits:The success
of any company depends on its employees. For us, employee
satisfaction is crucial not only to the well-being of our
organization, but also to the health and wellness of our members.
As such, we are firmly dedicated to providing our employees the
options and resources necessary for building security and
maintaining a healthy balance between work and life.Our dedication
to our staff is evident in our comprehensive benefits package. We
offer a very generous mixture of benefits, including many
employer-paid options.Health and Wellness:
- Employer-paid comprehensive medical, pharmacy, and dental for
- Vision insurance
- Zero co-payments for employed physician office visits
- Flexible Spending Account (FSA)
- Employer-Paid Life Insurance
- Employee Assistance Program (EAP)
- Behavioral Health ServicesSavings and Retirement:
- 401k Retirement Savings Plan
- Income Protection InsuranceOther Benefits:
- Vacation Time
- Company celebrations
- Employee Assistance Program
- Employee Referral Bonus
- Tuition Reimbursement
- License Renewal CEU Cost Reimbursement Program
- Business-casual working environment
- Sick days
- Paid holidays
- MileageEmployer will consider for employment qualified
applicants with criminal histories in a manner consistent with the
requirements of the LA City Fair Chance Initiative for Hiring
Ordinance. Requirements Education and / or Experience:
- Requires current CA driver's license and car insurance
- Previous management experience necessary.
- High level knowledge of Concurrent Review/Case Management
processes and principles
- Prior experience in MSO environment preferred.
- Ability to work with all levels of management.
- Must have excellent communications skills both verbally and
- Must have excellent organizational skills.
- Prior experience with project development and implementation
- Required to travel for new client implementation.
- Must have demonstrated knowledge of MS Office environment, and
Keywords: Regal Medical Group, Inc., San Bernardino , Manager, Inpatient Case Management, Executive , San Bernardino, California
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