TrueCare is a trusted healthcare provider serving San Diego and Riverside Counties, offering compassionate and comprehensive care to underserved communities. We are committed to making healthcare accessible to everyone, regardless of income or insurance status. With a focus on culturally sensitive, affordable services, TrueCare aims to improve the health of diverse communities. Our vision is to be the premier healthcare provider in the region, delivering exceptional patient experiences through innovative, integrated care.
The Director of Case Management is responsible for providing leadership and guidance for the Care and Case Management activities in the assessment, planning, intervention, referral, linkage, monitoring and evaluation of patients with serious, complex, or chronic health problems or psychosocial issues. This includes working in collaboration and continuous partnership with a multidisciplinary care team to achieve optimal outcomes and promote wellness, preventative care and disease management for patients. The Director of Case Management will oversee the various aspects of the Case Management program including but not limited to Remote Patient Monitoring, Transitions of Care, Utilization Management, Risk Stratification, Chronic Care Management (CCM), Enhance Care Management (ECM).
Duties & Responsibilities:
Use nursing standards, Patient-Centered Medical Home concepts, Value-Based Care and other emerging health innovation models to develop work processes and approaches for implementing a centralized Case/Care Management department.
Will work in collaboration to develop a comprehensive care plan to address individual patients with their physical, mental, and socials needs as well as reduce barriers that may prevent them from accessing care.
Ensure Department is compliant for follow-up of Identifying the patients that are high utilizers of care while promoting quality of care. Follows up post ED or hospital visits, by engaging patients with their continuity of care.
Provide clinical support to care coordinators in their coordination of services for patients with the education and resources to help with the management of their conditions and avoid unnecessary ED visits and hospitalizations.
Increasing care gap closures to ensure high quality care based on individual care needs.
Provide clinical support to Supervisors in their coordination of services for patients, especially those with complex, chronic health problems, abnormal screenings, and/or psychosocial issues.
Develops and administers case management policies and procedures with the goal of balancing quality patient outcomes with cost-effectiveness.
Implement, monitor, and track timeliness and completeness of transitions of care.
Promote multidisciplinary collaboration, provider relations, and engagement of family and caregivers to enhance the continuity of care for TrueCare patients.
Drive measurable improvement in chronic care management, population health, and clinical outcomes, while meeting requirements of regulatory agencies or payers.
Maintain relationships with health plans to ensure comprehensive care for high-risk patients.
Provide clinical support to care coordinators in the coordination of services for patients, especially those with complex, chronic health problems, abnormal screenings, and/or psychosocial issues.
Ensure staff patient panel workloads are assigned appropriately.
Monitor and evaluate the effectiveness of the care management activities including responsiveness and modify, as necessary.
Investigate and respond to client and provider complaints regarding quality of care as related to care management.
Oversee the staff use of electronic documentation systems in compliance with standard TrueCare processes, with a standard documentation style that is aligned with the Health Insurance Portability and Accountability Act (HIPAA) regulations.
Promote multidisciplinary collaboration, provider relations, and engagement of family and caregivers to enhance the continuity of care for TrueCare patients.
Work collaboratively with key leadership teams for the development and maintenance of clinically appropriate, cost-effective care management processes.
Track and trend data to identify opportunities to optimize patient care in collaboration with related departments.
Drive measurable improvement in chronic care management, population health, and clinical outcomes, while meeting requirements of regulatory agencies or payers.
Facilitate complex clinical and financial decision making by presenting thoroughly analyzed cases requiring higher administrative approval or intervention.
Establish and implement integrated continuous quality improvement process and customer satisfaction to assure high quality care, customer satisfaction and contribution to financial performance.
Ensure care coordinators are aligned with and follow the Team-Based Care model and strategic operational business goals.
Maintain relationships with health plans to ensure comprehensive care for high-risk patients.
Facilitate case conferences as needed.
Measures effectiveness of case management, quality, or utilization management initiatives by tracking admission/readmission rates, medical resource usage, or other performance metrics.
Reviews team activities and operations for compliance with established policies and standards
Qualifications:
Bachelor of Science in Nursing (BSN) degree.
Three to five (3-5) years of RN experience.
At least three (3) years’ experience in case management.
At least five (5) years of experience in management or leadership role.
Requires a keen attention to detail.
Knowledge of medical terminology, legal and technical aspects of a medical records system, HIPAA guidelines and ICD-10 and CPT codes.
Computer proficiency, particularly with Electronic Health/Medical Record systems and the Microsoft 365.
Case Management certification is desirable
Experience working in an outpatient setting or Federally Qualified Health Center (FQHC) is a plus.
Utilization Management experience.
Bilingual Spanish is a plus.
Benefits:
Competitive Compensation
Competitive Time Off
Low-cost health, dental, vision & life insurance
Tuition Reimbursement, Employee Assistance program
The pay range for this role is $94,000 - $141,000 on an annual basis.
TrueCare is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of race, color, religion, creed, national origin, ancestry, sex, gender, age, physical or mental disability, veteran or military status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state, or local law. Our goal is to promote and ensure authentic inclusion, belonging and support for all team members recruited or employed here. In the spirit of pay transparency, we are excited to share the base salary range for this position.
If you are hired at TrueCare, your final base salary (within the pay range), will be determined based on factors such as education, knowledge, skills, and experience. In addition to those factors, we believe in the importance of pay equity and consider the internal equity of our current team members when determining any final offer. Please keep in mind that the range mentioned above is the full base salary range for the role. Hiring at the maximum of the range would not be typical to allow for future and continued salary growth. We also offer generous benefits and retirement plans.
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