Regional Director of Case Management

Join the Southwest Healthcare Team!

About Us:

Creating Health and Harmony, Southwest Healthcare is a comprehensive network of care with convenient hospital and ambulatory care/outpatient locations here to serve the Southern California community. With over 6,000 passionate providers and healthcare employees, our shared goal is to provide convenient access to a wide range of healthcare services in a way that benefits you, your family, and the entire community.

Southwest Healthcare is comprised of five acute care hospitals and several non-hospital access points, including: Corona Regional Medical Center, Palmdale Regional Medical Center, Southwest Healthcare Rancho Springs Hospital, Southwest Healthcare Inland Valley Hospital and Temecula Valley Hospital, Temecula Valley Day Surgery, A+ Urgent Care Centers, Riverside Medical Clinics, and APEX Heart Specialists. For more information on how to join our dynamic team, please visit our website at www.swhealthcaresystem.com.

Job Summary:

Southwest Healthcare is seeking a Full-Time Regional Director of Case Management. This position will be responsible for providing leadership in the development, implementation, and oversight of a care coordination model which will support a patient-centered care delivery model at multiple facilities across the region. This position is responsible for the development and implementation of standards, systems, policies, and procedures in alignment with organizational strategic initiatives and that is focused on quality and financial outcomes. Specifically, this position leads region wide efforts to optimize care coordination across the care continuum. Duties include but not limited to:

• Oversees and/or directs the development, implementation and standardization of region-wide care coordination, utilization management, and social work services policies, procedures and programs in conjunction with related goals and objectives.
• Ensures compliance with federal and state regulations, as well as established organizational policies and procedures.
• Provides oversight for the medical necessity reviews, denials management, and utilization management supporting all areas of the organization within the assigned region. This includes strategy development which will improve reimbursements and reduce denials as related to federal, state and commercial programs in partnership with UHS Partners.
• Fosters integration and strong clinical partnerships with Hospitalists, physician advisors, local physician leadership and clinical integration activities in order to optimize care coordination across the care continuum, ensure efficient resource utilization, improve quality outcomes and enhance patient satisfaction.
• Reviews, prepares, analyzes, and presents reports and recommendations to senior management regarding operations and/or other applicable areas of interest in order to provide concise and accurate information that aids in decision-making. Develops, reviews, and monitors clinical, service and financial outcomes using performance metrics.
• Extensive understanding of case management practices and knowledge of reimbursement methodologies.
• Ability to identify and address customer needs in a team environment.
• Ability to effectively engage physicians, payers, management level staff, employees, and stakeholders in order to build partnerships, achieve strategic initiatives, and attain organizational goals.
• Ability to manage problems and situations where uncertainty is inherent constructing new and innovative solutions for complex and varying problems and situations while approaching issues/problems by considering the larger perspective or context.
• Analytical and conceptual system-thinking and the ability to manage multiple projects.
• Travel between all SoCal locations is required.

EDUCATION/TRAINING/ EXPERIENCE:

• Bachelor's degree from an accredited College or University in related field required, BSN or LCSW preferred.
• Master's degree from an accredited College or University in Business and/or Healthcare Administration preferred.
• Eight (8) to Ten (10) years of clinical experience as a Registered Nurse or LCSW is required.
• Minimum five (5) years acute care nursing leadership experience in Case Management required.

CERTIFICATIONS/LICENSES:

• Current license as a Registered Nurse in the State of California or LCSW required.
• Current CA Drivers License required.

OTHER SKILLS AND ABILITIES:

• Demonstrates knowledge and ensures compliance with the The Joint Commission and Title 22 standards and guidelines.
• Demonstrates compliance with healthcare policies and procedures at all times.
• Demonstrates strong leadership, organization, communication and interpersonal skills.
• Demonstrates ability to relate to clinical personnel and medical staff, as well as ability to interact well with the public.
• Must have knowledge of PC and applications.
• Develops plans of corrective actions with Corporate and Regional Care Management partners.
• Schedules periodic site visits to provide supervision, clinical expertise, ensure communication, and to monitor the overall operation the clinical services department.
• Conducts facility reviews based on operational needs, changes in management and commitment to regulatory compliance.
• Provide in-service training and orientation to facility staff regarding survey process, care management, corporate compliance, performance improvement, utilization management, etc.

Benefit Highlights:

• Challenging and rewarding work environment.
• Competitive Compensation & Generous Paid Time Off.
• Excellent Medical, Dental, Vision and Prescription Drug Plans.
• 401(K) with company match and discounted stock plan.
• SoFi Student Loan Refinancing Program.
• Tuition, CEU, Certification, Licenses Reimbursement program.
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: UHS Guest Benefits.

Southwest Healthcare is owned and operated bysubsidiariesofUniversal Health Services, Inc. (UHS), a King of Prussia, PA-based company, one of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees. Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

EEO Statement:

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams:

We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.