utilization manager

Kaiser Permanente

<div><div>Job Summary:</div> 
 
The Complex Case Manager is a Nationally Board Certified Professional. He/she is responsible for performing all activities on members referred to the complex case management program. This includes a comprehensive clinical evaluation, assessment and documented care plan in all domains including social determinants of health, psycho-social, financial, medications, ADL/IADLs and cognitive, coordinating and monitoring all services needed with a focus on providing education and the goal of self-management skills. Additional responsibilities include ensuring continuity of care through interaction and team- work with the Inpatient Case/Care Managers, Transition of Care staff, QRM staff, Population Care staff, Medical Office staff, Social Workers, Vendors and other KPGA staff. Educates Providers, member and caregivers and the promotion of quality care and a high level of member and/or caregiver satisfaction. The Complex Case Manager will ensure work demonstrates adherence to NCQA Standards of Excellence.<div> 
Essential Responsibilities:</div> 
 
<ul><li>Reviews all referrals to the Complex Case Management Programs within designated timeframe per policy and procedure and evaluate for case management based on established guidelines to ensure compliance with NCQA standards. This includes the preliminary evaluation of benefits within KPGA and community resources available.</li><li>
Performs a thorough and objective assessment of the member including physical, psychosocial, environmental, financial, and health status expectation through the use of EMR and hospital records, contact with the member, significant others, caregivers and current medical caregivers (if permitted by the member).</li><li>
Obtains consent from the member/caregiver for participation in Complex Case Management.</li><li>
Develops a comprehensive plan of care based on the assessment and in conjunction with the treating practitioner, identifies specific interventions, objectives, and goals with anticipated targeted dates for member accomplishment and self-management.</li><li>
Communicates the plan of care to the member/caregiver and provides education to the regarding the members condition as necessary.</li><li>
Implements the plan of care and specific interventions that will lead to the accomplishment of goals as defined in the plan of care.</li><li>
Establishes specific dates for follow-up and assesses the members status and progress toward the established goals and adjusts the plan of care as necessary.</li><li>
Performs referrals to other KPGA programs and coordinate referrals to community resources necessary to accomplish the goals and makes recommendations for modifications to the plan of care as necessary.</li><li>
Continuously evaluates and monitors all activities and/or services provided through the case management plan to determine the effectiveness of the plan.</li><li>
Documents all case management interactions and interventions according to guidelines including any pertinent patient information or arrangements in the members medical record.</li><li>
Identifies and Evaluates expected outcomes, utilization of services and associated costs of the plan of care as well as any proposed alternative plan of care and makes the necessary revisions.</li><li>
Coordinates and participates in case conferences on a regular basis with all Providers involved in the care and updates the plan of care as necessary.</li><li>
Continuously coordinates, monitors, tracks and evaluates all care and services rendered to ensure that quality care is being delivered in the most appropriate setting.</li><li>
Assists in the development and implementation of Continuous Quality Improvement (CQI) projects.</li><li>
Works closely with the member and practitioner to ensure that the most appropriate and cost- effective services are always provided to the member while maintaining quality outcomes.</li><li>
Performs hospital discharge follow up on assigned population. Arranges, coordinates, and facilitates appointments for the member as necessary.</li><li>
Maintains effective interaction/communication with members, nursing staff, inpatient care coordinators, the transitional review team, social workers, general reviewers, referral coordinators, and Kaiser Permanente medical offices to facilitate the case management process and to provide continuity of care.</li><li>
Identifies the need for discharge from the Case Management Program based on defined goals and criteria, and discharges the member after notifying the member and practitioner as well as any other resources such as the Social Worker, Transitional Review Team, etc.</li><li>
Performs as an integrated health care team member, providing continual education to HCT staff as to role and responsibilities in care coordination. Remains accessible to the HCT and attends all HCT meetings as appropriate.</li><li>
Collaborates effectively with Providers and other departments within the health plan by acting as a resource to TSPMG Providers, contracted consultants, Health Plan administrators and medical office staff and other departments within the organization.</li><li>
Provides case management updates to Providers and health care teams.</li><li>
Performs home visits as appropriate for members in case management.</li><li>
Knowledgeable and compliant with regional personnel, unit specific and departmental policies and procedures. Assists in the development of department protocols as needed.</li><li>
Participates in annual regional and departmental compliance training.</li><li>
Knowledgeable and compliant with Principles of Responsibility.</li><li>
Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanentes policies and procedures.</li><li>
Access to protected health information (PHI) will be limited to the minimum necessary required to effectively perform the job.</li><li>
Demonstrates understanding of HIPAA privacy regulations by maintaining confidentiality of Protected Health Information (PHI).</li><li>
Demonstrates doing the right thing and doing things the right way is an underlying premise in all work- related activities and is able to identify location of copy of Principles of Responsibility.</li><li>
Develops and maintains an awareness of how to report compliance issues and concerns. Identifies issues of wrong- doing and promptly investigates and reports to immediate supervisor or Director of Regional Compliance. Serves as a primary contact person between the medical offices and community agencies as it relates to coordinating and facilitating the appropriate level of care and provision of services.</li><li>
Collaborates with the social worker to provide information to members and HCTs regarding community resource referrals.</li><li>
Remains knowledgeable of contract benefits and current, industry utilization trends relevant state and Federal regulations, criteria, documentation requirements (including Medicare and HCFA) and laws that affect managed care and case/utilization management.</li><li>
Investigates, identifies and reports problems and inefficiencies in existing systems, and recommends changes when appropriate to the Team Leader and/or Manager.</li><li>
Under the guidance of the Team Leader and in consultation with other QRM and IQM staff, participates in the coordination, planning, development, implementation, and maintenance of all Complex Case Management Program department policies and procedures.</li><li>
Reviews the statistics of case management interventions with the Supervisor/Team Leader and adjusts based on findings.</li><li>
Performs quality of care and service reviews using identified quality indicators and refers cases identified as risk management, peer review or quality issues to Quality and Risk Management.</li></ul><div> 
Basic Qualifications:</div>
<div>Experience</div> 
 
<ul><li>Minimum five (5) years of RN Clinical Nursing, social work, case management or utilization management (UM).</li><li>
Equivalent combination of case management/social work/UM training or RN experience may be considered.</li></ul><div>
Education</div> 
 
<ul><li>High School Diploma or General Education Development (GED) required.</li></ul><div>
License, Certification, Registration</div>
<ul><li>Licensed Master Social Worker (Georgia) OR Licensed Clinical Social Worker (Georgia) OR Registered Professional Nurse License (Georgia) required at hire
</li></ul><ul><li>Case Manager Certificate within 12 months of hire from Commission for Case Managers Certification 
</li></ul><div>
Additional Requirements:</div> 
<ul><li>
Complex Case Management experience and/or certification.
</li><li>Excellent/highly skilled in the management of chronic conditions such as diabetes, cardiovascular conditions, behavioral-health, and chronic obstructive lung disease management COPD.</li><li>
Ability to work collaboratively with multiple healthcare professionals.</li><li>
Experience with managed health care delivery, benefits knowledge including Medicare and Medicaid.</li><li>
Functional knowledge of computers.</li><li>
Knowledge of ICD9/ ICD10 and/or CPT4 coding beneficial.</li><li>
Working knowledge of all relevant federal, state, local and regulatory requirements including Medicare/HCFA.</li></ul><div>
Preferred Qualifications:</div> 
 
<ul><li>Bachelors Degree in Nursing strongly preferred or four (4) years of experience in related field.</li></ul> 
PrimaryLocation : Georgia,Atlanta,Regional Office - 9 Piedmont 
HoursPerWeek : 40 
Shift : Day 
Workdays : Mon, Tue, Wed, Thu, Fri 
WorkingHoursStart : 08:30 AM 
WorkingHoursEnd : 05:00 PM 
Job Schedule : Full-time 
Job Type : Standard 
Employee Status : Regular 
Employee Group/Union Affiliation : GUP|UFCW|Local 1996 
Job Level : Individual Contributor 
Job Category : QA, UR &amp; Case Management 
Department : Regional Office - 9 Piedmont - Rgnl Mg Admn-Ccs Case Coord - 2808 
Travel : No 
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.</div>

Complex Case Manager

Hill Physicians Medical Group

<div>We&rsquo;re delighted you&rsquo;re considering joining us!
At Hill Physicians Medical Group, we&rsquo;re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.
Join Our Team!
Hill Physicians has much to offer prospective employees. We&rsquo;re regularly recognized as one of the &ldquo;Best Places to Work in the Bay Area&rdquo; and have been recognized as one of the &ldquo;Healthiest Places to Work in the Bay Area.&rdquo; When you join our team, you&rsquo;re making a great choice for your professional career and your personal satisfaction.
DE&amp;I Statement:
At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.
We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!
Job Description:
Responsible for carrying out case management activities for IPA members referred to the case management program across all levels of care. Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services required to meet the client&rsquo;s health and human service needs. It is characterized by advocacy, communication and resource management and promotes quality and cost-effective interventions and outcomes. Case management activities are based on nationally recognized case management standards and concepts and principles. All contacts are telephonic with an option for on-site case conferences as needed.
Job Responsibilities<ul><li>
Identification of members appropriate for case management, based on identification of health-related problems.</li><li>
Assessing members&rsquo; physical and psychosocial needs/barriers.</li><li>
Developing the case management care plan.</li><li>
Developing and implementing the interventions needed to resolve barriers and coordinate care, allowing members to accomplish their goals with physician guidance and supervision.</li><li>
Documenting assessments, care plans, interventions, and all other activity related to coordinating the care of case-managed members.</li></ul>
Additional Responsibilities<ul><li>
Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.</li><li>
Maintain department procedure/policy standards with regard to turnaround time, etc.</li><li>
Support the interdisciplinary team approach to ensure effective resource utilization, as well as quality and cost-effective outcomes.</li><li>
Coordinate internal and external resources for the individual member.</li><li>
Maintain and update a community resource database.</li><li>
Document all case management activities in the HPMG case management online system.</li><li>
Utilize existing reports and systems to identify and monitor utilization resource patterns and facilitate needed care coordination in order to support Quality Improvement.</li><li>
Refer to various departments for supportive interventions, i.e., Health Education, Quality Management, Contracting, Provider Services, Client Data Management, TPL, COB, etc.</li><li>
Issue letters of explanation in accordance with department policy.</li><li>
Support Medical Management Team, Authorization Review, Clinical Initiatives, and Provider Education.</li><li>
Attend and participate in in service programs and conferences that support practice of case management.</li><li>
Perform other duties as assigned.</li></ul>
Required Experience<ul><li>
Minimum 3 &ndash; 5 years of experience required</li><li>
Minimum three years clinical nursing experience in an area such as medical surgical, critical care, home health or skilled nursing, and;</li><li>
Two years of experience in case management, utilization management, discharge planning and or quality improvement in a managed care setting</li><li>
Experience with managed care delivery including IPA networks and Medicare.</li><li>
Optimum organizational skills with ability to meet both expected and unexpected time frames.</li><li>
Excellent verbal and written communication skills.</li><li>
Ability to coordinate effectively with a variety of customers including members, providers, office staff, health plans, internal department, community resources, and peers.</li><li>
Ability to work independently with self-initiative and discipline.</li><li>
Knowledge of ICD-10 and or CPT coding.</li><li>
Working knowledge of personal computers.</li></ul>
Required Education<ul><li>
A.S. degree</li><li>
Unrestricted California Registered Nurse licensure; certification in case management preferred.</li></ul>
Additional Information
Salary: $100,000 - $123,000 Annual
Hill Physicians is an Equal Opportunity Employer</div>

Case Manager - 26-44

Case Manager - 26-43

Cambia Health Solutions

<div>
 
 Remote Care Management Nurse (Future Opportunities)
 
 
 
 
 Work from home within Oregon, Washington, Idaho or Utah
 
 
 
 
 *
 
 Please be advised that this role is part of our candidate pool, which allows us to identify and attract exceptional talent for future opportunities. Although we may not have immediate openings, we invite you to submit your resume for consideration. By doing so, you will be included in our database and considered for all suitable positions as they become available, ensuring that you are among the first to be notified of new opportunities that match your skills and experience.*
 
 
 
 Build a career with purpose. Join our
 
 
 Cause
 
 
 to create a person-focused and economically sustainable health care system.
 
 
 
 
 Who We Are Looking For
 
 
 
 Every day, Cambia&rsquo;s dedicated team of Care Management RN's are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Care Management RN's provide clinical care management (such as case management, disease management, and/or care coordination) to best meet the member&rsquo;s specific healthcare needs and to promote quality and cost-effective outcomes. Oversees a collaborative process with the member and those involved in the member&rsquo;s care to assess, plan, implement, coordinate, monitor and evaluate care as needed - all in service of creating a person-focused health care experience.
 
 
 Are you a Registered Nurse looking to transition out of bedside care and into a role that still utilizes your clinical expertise, but offers a fresh challenge? Is your goal to promote quality, cost-effective outcomes and improve overall health and wellbeing? Then this role may be the perfect fit.
 
 
 
 Qualifications
 
 
 
 
 What You Bring to Cambia:
 
 
 
 <ul>
 <li>
 Nursing or health/human services degree (Associate's or Bachelor's minimum), or equivalent experience in lieu of a degree
 </li>
 <li>
 At least 3 years of direct clinical care or experience in case management, utilization management, disease management, auditing, or retrospective review
 </li>
 <li>
 Active, unrestricted licensure or certification in a U.S. state or territory that allows you to independently conduct assessments within your scope of practice &mdash; RN license required for medical care management
 </li>
 <li>
 Must be eligible for licensure in Idaho, Oregon, Utah, and Washington
 
 
 </li>
 </ul>
 
 Skills And Attributes
 
 
 
 <ul>
 <li>
 Knowledge of health insurance industry trends, technology and contractual arrangements.
 </li>
 <li>
 General computer skills (including use of Microsoft Office, Outlook, internet search).
 </li>
 <li>
 Familiarity with health care documentation systems.
 </li>
 <li>
 Strong oral, written and interpersonal communication and customer service skills.
 </li>
 <li>
 Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively.
 </li>
 <li>
 Strong organization and time management skills with the ability to manage workload independently.
 </li>
 <li>
 Ability to think critically and make decision within individual role and responsibility.
 </li>
 <li>
 Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
 
 
 </li>
 </ul>
 
 What You Will Do At Cambia
 
 
 
 <ul>
 <li>
 Conducts case management activities, including assessment, planning, implementation, coordination, monitoring, and evaluation to identify and meet member needs.
 </li>
 <li>
 Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care, utilizing evidence-based criteria and practicing within the scope of their license.
 </li>
 <li>
 Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions and participating in quality improvement efforts.
 </li>
 <li>
 Serves as a resource to internal and external customers, responding to inquiries in a professional manner while protecting confidentiality of sensitive documents and issues.
 </li>
 <li>
 Provides consistent and accurate documentation, ensuring compliance with performance standards, corporate goals, and established timelines.
 </li>
 <li>
 Coordinates resources, organizes, and prioritizes assignments to meet goals and timelines.
 </li>
 <li>
 Monitors and evaluates the effectiveness of case management plans, gathering sufficient information to determine the plan's effectiveness and making adjustments as needed.
 
 
 </li>
 </ul>
 The expected hiring range for a Care Management Nurse is $36.80 &ndash; $49.80 per hour, depending on skills, experience, education, and training; relevant licensure/certifications; and performance history. The bonus target for this position is 10%. The current full salary range for this role is $34.20 &ndash; $55.70 per hour. Please let me know if you have any questions.
 
 
 
 About Cambia
 
 
 
 Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
 
 
 
 Why Join the Cambia Team?
 
 
 
 
 At Cambia, You Can
 
 
 
 <ul>
 <li>
 Work alongside diverse teams building cutting-edge solutions to transform health care.
 </li>
 <li>
 Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
 </li>
 <li>
 Grow your career with a company committed to helping you succeed.
 </li>
 <li>
 Give back to your community by participating in Cambia-supported outreach programs.
 </li>
 <li>
 Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
 
 
 </li>
 </ul>
 We believe a career at Cambia is more than just a paycheck &ndash; and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
 
 
 
 Benefits
 
 
 
 In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
 
 
 <ul>
 <li>
 Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
 </li>
 <li>
 Annual employer contribution to a health savings account.
 </li>
 <li>
 Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
 </li>
 <li>
 Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
 </li>
 <li>
 Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
 </li>
 <li>
 Award-winning wellness programs that reward you for participation.
 </li>
 <li>
 Employee Assistance Fund for those in need.
 </li>
 <li>
 Commute and parking benefits.
 
 
 </li>
 </ul>
 
 Learn More About Our Benefits.
 
 
 
 We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
 
 
 We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
 
 
 If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
 
 
</div>

Remote Care Management Nurse

Listgrove Ltd

<div>
 
 The Operations Manager is responsible for multiple production facilities, covering a daily throughput of approximately 4,000 MT material &ndash; metal and non-metals. The role covers inbound receiving, processing, and outbound shipping, and carries accountability for how each stage is organized, performed, and continuously improved across all sites. The role is built on 3 operational disciplines of equal importance. Standardization, Efficiency, and Capacity Utilization.
 
 
 This is a field-based role that requires regular personal presence across all facilities. The quality of operations at this scale is best assessed and improved through direct supervision and engagement, not through remote reporting. The right candidate brings the technical depth to assess what they see, the interpersonal credibility to influence how teams work, and the leadership maturity to drive sustained improvement across a complex, multi-site network.
 
 
 
 
 
 Key Responsibilities
 
 
 
 
 
 
 Team Leadership
 
 
 
 The Operations Manager leads Processing Team Leaders and their teams of processing supervisors across all sites. Building capable, accountable, and improvement-oriented teams at every level is a defining and continuous dimension of the role.
 
 
 
 
 
 
 Standardization
 
 
 
 A consistent standard operating model is the foundation on which efficiency and capacity utilization are built. Without clearly defined and enforced standards across all yards, each site tends toward its own working practices, and inconsistency at scale is where operational performance is lost before it can be measured or improved.
 
 
 
 
 
 
 Efficiency
 
 
 
 Operational efficiency is the measure of how material moves through each stage of the cycle, from receiving at the gate to dispatch from the yard. Unnecessary handling steps, avoidable delays, poor staging decisions, and rework at any stage reduce the value of the work performed without contributing to output. The Operations Manager is responsible for identifying these losses systematically and eliminating them from the operational model across both streams and all yards.
 
 
 
 
 
 
 Capacity Utilization
 
 
 
 Capacity Utilization measures how much of the available capacity, in equipment, machinery labors, and transportation, is being productively used. Closing the gap between what the assets can produce and what they actually produce through operational planning, scheduling discipline, and resource deployment management is a central accountability of this role.
 
 
 
 
 
 
 Commercial Interface
 
 
 
 The Operations Manager serves as the primary link between the operational network and the commercial team through 2 way effective communication that translates commercial demand into operational planning, while feeding operational performance and capacity data back into commercial decision-making.
 
 
 
 
 
 
 Safety Compliance
 
 
 
 The Operations Manager ensures that all operational activities across the receiving, processing, and shipping cycle comply fully with applicable safety standards, and that safe working requirements are embedded as an integral part of the standard operating model at every stage.
 
 
 
 
 
 
 Education, Skills &amp; Experience
 
 
 
 
 
 
 
 Education
 
 
 
 A recognised qualification + proven experience is a key requirement.
 
 
 
 
 
 
 Experience
 
 
 
 10 years or more in a senior operations management in a bulk material processing, heavy manufacturing, or commodity handling environment.
 
 
 
 
 
 
 Technical Knowledge
 
 
 
 Working knowledge of bulk material processing equipment to assess utilization, identify workflow inefficiencies, and engage productively with maintenance and equipment teams. Familiarity with shift scheduling design as a tool for improving equipment and labor utilization across a multi-site network. Understanding of OEE principles and their application in an industrial processing environment. Experience with ERP or operational management platforms for production scheduling, capacity planning, and performance monitoring. Practical application of Lean, Six Sigma, or equivalent continuous improvement methodologies across multiple sites, with demonstrated impact on efficiency or utilization outcomes. Experience with multi-modal outbound logistics, truck, and container, with demonstrated improvement in load utilization across a dispersed network. Familiarity with commodity trading dynamics and the relationship between operational decisions and their commercial implications.
 
</div>

Group Operations Manager

Gila River Health Care

<div>Summary :
The Case Manager will provide comprehensive Case Management for patients as assigned to include, but not limited to: assessing patient&rsquo;s needs; developing, implementing, monitoring, and documenting the progress of the patient throughout their hospitalization in an outside area hospital to meet their care needs prior to discharge. The intensity of Case Management is situational and appropriately based on patient need. This position is accountable for the quality of clinical services provided by both them and others and identifies barriers which may hinder effective patient care. The Case Manager performs Utilization Review of the medical necessity and appropriateness of care using InterQual criteria of patients admitted to Gila River Health Care inpatient unit: assessing patient admissions and continued stay criteria to identify issues that may delay patient discharge and facilitate resolution of these issues. 
 
Critical Tasks:
<ul><li>Demonstrates a culture of kindness through all interactions whether verbal or non-verbal with all GRHC staff members, partner facilities staff and vendors.
</li></ul><ul><li>Manages and oversees assigned patient case load to ensure delivery of all covered services identified for continuity of care across all levels of care and involved providers to achieve the optimal clinical, financial, operational, and patient satisfaction outcomes.
</li></ul><ul><li>Maintains HIPAA standards of patient confidentiality during all interactions whether written, verbal, or electronic.
</li></ul><ul><li>Establishes and promotes a collaborative relationship with members of the healthcare team within GRHC and outside facility partners.
</li></ul><ul><li>Serves as Case Manager between referral hospitals, treatment facilities and patients/patient&rsquo;s families to ensure delivery of effective and appropriate assistance and follow-up for returning to pre/post hospitalization status/care.
</li></ul><ul><li>Reviews charts of assigned patients to determine appropriate referral services based on assessed patient needs.
</li></ul><ul><li>Facilitates, schedules and/or participates in a variety of patient Case Management activities to ensure patient and/or family personal and health care needs are met in a timely manner; proactively identifies alternative resources as needed.
</li></ul><ul><li>Participates in &ldquo;on-call&rdquo; for Case Management Department and Utilization Review
</li></ul><ul><li>Performs Utilization Review of patient chart to ensure compliance with established InterQual criteria to maximize reimbursement/coverage of charges.
</li></ul><ul><li>Evaluates inpatient medical necessity and appropriateness of care utilizing InterQual criteria, for optimizing outcomes.
</li></ul><ul><li>Assesses patient admissions and continued stay to identify issues that may delay patient discharge and communicates to the interdisciplinary team while facilitating a resolution.
</li></ul><ul><li>Collects and communicates pertinent, timely information to the health care team to fulfill utilization and regulatory requirements.
</li></ul><ul><li>Collaborates with patient, family members, and other involved parties to ensure care coverage through private and governmental health care plans.
</li></ul><ul><li>Collects outcome data to be used in identifying best practices and targeting performance improvement solutions.
</li></ul><ul><li>Participates in departmental orientation, on the job training, and quality assurance programs/initiatives.
</li></ul><ul><li>Receives and responds to patient concerns; research issues for corrective action as appropriate based on findings; escalates physician/provider concerns to appropriate parties and identifies alternative solutions.
</li></ul><ul><li>Participates in a variety of department and hospital educational programs to maintain current skill and competency levels; identifies and discusses performance or training needs with Supervisor.
</li></ul><ul><li>Participates in Community Events representing GRHC and Case Management Department with ability to educate on departmental functions.
</li></ul><ul><li>Other duties as assigned by Case Management Director/Manager
</li></ul><ul><li>Establishes goals and objectives for the department that meet or exceed GRHC&rsquo;s Code of Ethics and Standards for Conduct Policy.
</li></ul><ul><li>Is familiar and remains current on safety and emergency management process for the department.
</li></ul>Required Qualifications:
<ul><li>Current State of Arizona or Compact State Registered Nurse license, BSN preferred.
</li></ul><ul><li>Current CPR for Healthcare professional's certification
</li></ul><ul><li>Must have at least 1-year previous case management experience, CCM certification preferred but must obtain within 2 years of hire.
</li></ul><ul><li>Experience must include working in an acute care and/or home care setting for at least a 12-month period.
</li></ul><ul><li>Native American population preferred.
</li></ul><ul><li>Must have a working knowledge of Case Management, acute care and/or home care environments, community resources and resource/utilization management.
</li></ul><ul><li>Case Management Specialty Area Requirements :
<ul><li>Pediatrics Case Manager &ndash; Must have at least 1 year Pediatrics experience
</li><li>Cancer Case Manager &ndash; Must have at least 1 year oncology/hospice/or cancer case management experience
</li><li>Pain Management Case Manager &ndash; Must have at least 1 year experience working with pain management patients/hospice patients .
</li><li>Women&rsquo;s Health/High Risk Pregnancy Case Manager &ndash; Must have at least 1 year Women&rsquo;s Health/Pregnancy experience
</li><li>Family Medicine Case Manager &ndash; Must have at least 1 year Medical-Surgical or Family Clinic experience
</li><li>Internal Medicine Case Manager - Must have at least 1 year Medical-Surgical or Family Clinic experience
</li><li>Emergency Department/Utilization Review Case Manager &ndash; Must have 1 year Medical-Surgical experience and/or 1 year Utilization Review experience</li></ul></li></ul></div>

Case Manager-Case Management-HHK-Sacaton

Anwar Khawaja Industries Pvt. Limited

Job PurposeThe Manager Operations is responsible for planning, coordinating, and supervising daily operational activities to ensure efficient production, optimum resource utilization, quality compliance, and timely delivery of products in line with organizational objectives.Key Responsibilities1. Operational Management<ul><li>Oversee overall operations including production, planning, logistics, and workflow management. Liason with manufacturing units.</li><li>Ensure smooth execution of daily operational activities.</li><li>Develop and implement operational strategies to improve productivity and efficiency.</li><li>Monitor operational performance against KPIs and targets.</li></ul>2. Production Planning &amp; Control<ul><li>Coordinate with production teams to achieve production targets.</li><li>Ensure optimum utilization of manpower, machines, and materials.</li><li>Monitor production schedules and resolve operational bottlenecks.</li><li>Ensure on-time order completion and delivery commitments.</li></ul>3. Process Improvement<ul><li>Identify process inefficiencies and implement continuous improvement initiatives.</li><li>Introduce cost-saving and productivity enhancement measures.</li><li>Implement Lean Manufacturing / Operational Excellence practices.</li></ul>4. Quality &amp; Compliance<ul><li>Ensure compliance with company quality standards and customer requirements.</li><li>Coordinate with Quality Assurance for defect reduction and process control.</li><li>Maintain compliance with safety, environmental, and regulatory standards.</li></ul>5. Team Management<ul><li>Supervise department heads, supervisors, and operational staff.</li><li>Develop workforce capability through training and performance management.</li><li>Conduct performance reviews and ensure discipline and accountability.</li></ul>6. Coordination &amp; Communication<ul><li>Liaise with Sales, Planning, Procurement, HR, and Finance departments.</li><li>Coordinate customer requirements with operational execution.</li><li>Prepare operational reports for management review.</li></ul>7. Cost &amp; Resource Management<ul><li>Monitor operational costs and control wastage.</li><li>Improve efficiency in material consumption and labor utilization.</li><li>Support budgeting and cost optimization initiatives.</li></ul>8. Health, Safety &amp; Workplace Management<ul><li>Ensure implementation of health &amp; safety policies.</li><li>Promote safe working environment across all operational areas.</li><li>Conduct risk assessments and corrective actions.</li></ul>Key Performance Indicators (KPIs)<ul><li>Production efficiency</li><li>On-time delivery performance</li><li>Cost reduction achievement</li><li>Quality rejection rate</li><li>Machine utilization</li><li>Workforce productivity</li><li>Safety compliance</li></ul>Qualification &amp; Experience<ul><li>Bachelor&rsquo;s degree in Engineering / Industrial Management / Business Administration (Master&rsquo;s preferred).</li><li>7&ndash;10 years of relevant experience in operations or production management.</li><li>Strong leadership and problem-solving skills.</li><li>Experience in manufacturing environment preferred.</li></ul>Job Type: Full-timeWork Location: In person

Manager Operations

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