Manager - Case Management

JOB SUMMARYPlans, organizes, manages, evaluates and provides overall administration, direction, and management of the staff and day-to-day activities of Case Management/Utilization Review, one of two major organizational components within the hospital. The Case Management Manager acts as a consultant to the clinical team, service lines and other departments, and participates in program development and quality improvement initiatives. A hospital-based Case Management system has as its primary goal to ensure the most appropriate use of services by patients and, toward that end, to avoid duplication and misuse of medical services, control costs by reducing inefficient services, and improve the effectiveness of care delivery. Objectives are to facilitate timely discharge; prompt, efficient use of resources; achievement of expected outcomes; collaborative practice; coordination of care across the continuum; and performance/quality improvement activities that lead to optimal patient outcomes. ESSENTIAL FUNCTIONSThe essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned. Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings. Must perform all duties and responsibilities in accordance with the hospital's policies and procedures, including its Service Standards and its Code of Conduct. ResponsibilitiesAdvises the Director on the needs of the Case Management and Utilization Review function, such as staffing needs, supplies, equipment, space and other resources; recommends and participates in selecting outside sources for needed services.Develops and maintains an effective system of information, records and reports for assigned department(s) utilizing appropriate manual or electronic systems.Continuously assesses and improves department's performance based on customer needs; manages and participates in improving performance and services benefiting staff, patients and other customers.Determines fiscal requirements and assists in budget preparation for the department; monitors, verifies and reconciles expenditure of budgeted funds, including monthly variance reports.Maintains quality improvement and control programs; evaluates and implements changes based on data related to productivity, quality and outcomes for departmental projects and collaboration with the Director, plans, develops, implements and promotes a comprehensive program of Case Management and utilization review activities for the hospital and clinics; ensures policies and procedures meet external requirements.Leads and participates in program planning, identifying needs, organizing activities with other departments to ensure efficient coordination of services.Monitors patients length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and aligns with patient needs.Plans, coordinates and conducts staff meetings to ensure compliance with practices and regulatory requirements, implement new policies, and provide communication to staff.Provides leadership and management to licensed nursing professionals providing Case Management and utilization review services; recruits, hires, orients, and promotes staff; evaluates staff performance; ensures personnel policies are followed; provides supervision and mentoring to staff.Advises and confers with case managers on unusual or difficult cases; assigns, schedules, and reviews work to ensure adequate coverage.Provides leadership in intradepartmental planning, participates in task forces, committees and performance improvement initiatives; provides expertise for complex problem solving.Provides teaching to staff to enhance clinical knowledge and licensure; ensures ongoing education programs and orientation for new employees.Reviews and analyzes data and reports related to the provision of Case Management services. MINIMUM QUALIFICATIONSAny combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying. Education: Bachelor’s Degree in Nursing from an accredited college or university.Experience: Five (5) years of progressively responsible and directly related work experienceLicense/Certification:Registered Nurse by California Board of Registered Nursing KNOWLEDGEThese are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education or licensure/certification.Ability to make effective oral presentations and prepare concise written reports to a variety of audiences; monitor and assure the patient’s access to the appropriate level of care, the right providers, and the correct setting and services to meet patient needs; promote coordination and continuity in patient health care.Ability to provide appropriate patient care and clinical information when patients are admitted, referred, transferred, or discharged.Knowledge of applicable hospital policies, regulations, and standards of external accrediting and regulatory organizations; HIPAA; current medical issues and health trends.Knowledge of available patient services and treatment.Knowledge of nursing theory and practice, health care system, and accountability for practice outcomes.Knowledge of financial processes of various funding sources for health care services.Knowledge of medical terminology and related levels of care and treatment.Knowledge of administration, budgeting and personnel management; full continuum of care and integration of care components.Knowledge of models of case management, discharge planning, utilization review, and quality assurance/improvement.Knowledge of variables affecting processes and outcomes of patient health care. PHYSICAL REQUIREMENTSThe Physical Requirements and Working Conditions are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job. #LI-post Pay RangeCompensation is based on the level and requirements of the role. Salary within our ranges may also be determined by education, experience, knowledge, skills, location, and abilities, as required by the role, as well as internal equity and alignment with market data. Typically, new team members join at the minimum to mid salary range. Minimum to Midpoint Range (Hourly): $92.23 to $115.29 Stanford Medicine Children’s Health strongly values diversity and is committed to equal opportunity and non-discrimination in all policies and practices, including employment. SMCH does not discriminate on the basis of race, color, sex, sexual orientation or gender identity, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability. People of all genders, all racial/ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered under applicable law. #J-18808-Ljbffr

Created: 2025-09-17