Clinical Account Consultant
Health Care Service Corporation
Director, Care Management
Community Memorial Healthcare
full-time
Posted on:
Location Type: Office
Location: Santa Barbara • California • 🇺🇸 United States
Visit company websiteJob Level
Lead
About the role
- Oversight and direction of all clinical, business, safety, quality and regulatory dimensions relevant to inpatient and outpatient Care Management, Social Work, and Community Case Management.
- Partner with CH Population Health program to develop sustainable patient connections with community resources to promote healing and overall health.
- Provide leadership and strategic direction for care management operations across inpatient and outpatient settings.
- Ensure compliance with government regulations, payer reimbursement policies, utilization review (Interqual), and clinical documentation integrity.
- Collaborate with interdisciplinary teams to improve quality, safety, and patient outcomes.
- Facilitate quality management activities including team facilitation, data analysis, and report generation.
Requirements
- Minimum: Graduate of an accredited school of Nursing or Social Work, current RN or LCSW licensure in California or eligible.
- Preferred: Master’s Degree.
- Minimum: Current RN or LCSW license. Accredited Case Management (ACM) or Case Management Certification (CMS/CCM) to be obtained within 6 months of hire.
- Strong analytical abilities.
- Intermediate proficiency in Word, Excel, and PowerPoint.
- Quality Management skills including team facilitation, data analysis, and report generation.
- Extensive knowledge of case management and social work concepts and practice standards, clinical documentation integrity, government regulations, payer reimbursement, Interqual, utilization requirements, crisis intervention, relevant community services, and population health.
- Preferred: Knowledge of Accountable Care Organizations and Bundled Payment Systems.
- Familiarity with Epic and Quality database.
- Minimum: Three years of progressive experience in leadership and case management required.
- Preferred: 5 years of progressive experience in leadership and case management required. Two years clinical documentation improvement experience.
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical documentation integrityutilization reviewdata analysisreport generationquality managementcase managementcrisis interventionpopulation healthinterdisciplinary collaborationleadership
Soft skills
analytical abilitiesteam facilitationstrategic directioncommunicationcollaboration
Certifications
RN licenseLCSW licenseAccredited Case Management (ACM)Case Management Certification (CMS/CCM)
