MANAGER - CASE MANAGEMENT/SOCIAL SERVICES

Position Summary The Manager of Case Management &Social Servicesis responsible forthe overall leadership, management, and daily operations of the Case Management and Social Services departments. This position provides strategic and operational oversight to ensure the delivery of high-quality, patient-centered care coordination, discharge planning,utilizationmanagement, and psychosocial services across the continuum of care. The Manager collaborates with physicians, nursing leadership, ancillary departments, post-acute providers, and community agenciesto promote safe,timely, and efficient patient transitions while supporting regulatory compliance, quality outcomes, and financial stewardship. The Manager oversees a multidisciplinary team of registered nurse case managers, licensed clinical social workers, social workers, case management assistants, and other support staff. Responsibilities include supervising departmental operations, developing and implementing policies and procedures,monitoringkey performance indicators, managing departmental budgets, ensuring compliance with federal, state, and accreditation standards, and fostering a culture of collaboration, accountability, and continuousimprovement. This role is instrumental in reducing avoidable hospital days, improving patient flow, minimizing readmissions,optimizingresourceutilization, and enhancingthe patientand family experience. The Manager serves as a key leader in interdisciplinary care coordination,utilizationreview, complex discharge planning, population health initiatives, and value-based care strategies. The position also works closely with executive leadership to achieve organizational goals related to quality, patient safety, operational efficiency, regulatory compliance, and financial performance. The Manager of Case Management & Social Services promotes professional development, staff engagement, and evidence-based practice while ensuringequitableaccess to healthcare resources and advocacy for patients and families. This leader is expected tomaintainstrong relationships with skilled nursing facilities, home health agencies, hospice organizations, community resources, behavioral health providers, and payer organizations tofacilitateseamless transitions of care and improve health outcomes. What You'll Do (not all inclusive) Assumes a leadership/supervisory role byassistingwith the daily operations/functions of the department including scheduling, InterQual reviews, staff assignments, orientation ofnew staffmembers, and completion of Treatment Authorization Request (TAR) forms. Functions as the liaison to the Medi-Cal Managed Care program, medicalrecords,and the central business office. Develops andmaintainsCase management policies and procedures. Collaboratesin writing appeals fordenials,as necessary. Coordinates with outside agencies including but not limited to CPS/APS and psychiatric services andsharesinformation with associates. Coordinates Riverside County 5150 training and certification process for all SGMHdesignated5150 evaluators. Under the direction of the Chief Nursing Officer, generates, revises, and updates Utilization Management plans, policies, and procedures and coordinates the implementation of Case Management/Risk Management/Utilization Management activities within the hospital. Assistsin providing in-services on CM/InterQual Reviews/UM philosophy, policies, and procedures as needed; coordinates distribution of educational material on CM/InterQual Reviews/UM topics to appropriate hospital personnel. Coordinates concurrent review studies performed within the CM/InterQual Reviews/UM Program and prepares resulting reports. Manages the Social Services Department. Consistently places patient safety as the highest priority. ActivelyparticipatesonHospital Committees, asrequired.Assistswith facilitation of the Utilization Management Committee. Maintains and reports statistical information on admissions, LOS, etc. Maintains communication and promotes cooperation with other Departments. #J-18808-Ljbffr San Gorgonio Memorial Hospital