Regional Manager jobs in Fresno, CA

POSITION SUMMARY

Using discretion and independent judgment, the Case Manager is responsible for all case management activities assigned. This includes case management and utilization management. The Case Manager provides concise management of patients’ hospitalization from pre-admission through discharge in the areas of patient care, fiscal management, and Payor/referral satisfaction. The Case Manager is responsible for conducting Discharge Planning Evaluations, performing discharge planning to ensure patients and their families receive maximum benefits, and awareness of community and government agencies. This position requires the use of communication skills, the ability to perform management operations directly related to administrative goals and policies, to provide regular and direct assistance to executives, to perform work and special assignments under only very general supervision, and to continuously develop department operations toward efficiency and effectiveness.

POSITION QUALIFICATIONS

This position requires a MSW or LCSW with at least three (3) years of work experience in a medical case management setting. Exceptions are made with CEO approval. Good organizational and liaison capabilities with well-developed written and verbal communication abilities are required. Well demonstrated public relations skills with a cooperative and assertive attitude. Working knowledge of the insurance industry is required.

RESPONSIBILITIES

1. Have an understanding of the commercial insurance appeal process.