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Prime Healthcare

Acquires and reorganizes underperforming hospitals

Director of Case Management - Utilization Management

Medical, Clinical & VeterinaryPosted on Nov 5
Full-timeInglewood, CA, USA$108.2k - $163.8k /yrIn-person

About the Job

Requirements

  • A California Registered Nurse license is required.
  • A Bachelor of Science in Nursing is required.
  • For a Licensed Clinical Social Worker grandfathered prior to April 1, 2015, at least five years after graduating from an accredited school of social work is required.
  • At least five years of experience in a Case Management position is required.
  • Analytical ability to identify problems and assess and evaluate data and statistics obtained through an ongoing review process is required.
  • Basic to intermediate computer skills and knowledge are required.

Responsibilities

  • Lead the Case Management Team, including Registered Nurses, Social Workers, and Clinical Coordinators.
  • Oversee utilization management, discharge planning, and care coordination to ensure patients receive timely, appropriate, and efficient care throughout their hospital stay.
  • Develop staff and systems to operate a comprehensive Case Management Program effectively.
  • Provide leadership and supervision to case managers, social workers, case management coordinators and discharge planners, utilization review coordinators, and utilization technicians.
  • Assess needs and plan, communicate, and design services appropriate to the hospital mission and patient and family needs.
  • Integrate and coordinate services using continuous quality improvement tools.

Desired Qualifications

  • A current BCLS certificate is preferred.
  • Knowledge of Milliman Criteria and InterQual Criteria is preferred.

About the Company

Prime Healthcare

Acquires and reorganizes underperforming hospitals

Prime Healthcare operates a network of hospitals and outpatient centers across the United States, concentrating on turning around financially struggling facilities. It invests in infrastructure and technology, restructures operations, and negotiates payer terms (including pursuing higher out-of-network reimbursements) to improve financial performance, and it manages both for-profit hospitals and not-for-profit facilities through the Prime Healthcare Foundation. The company aims to raise clinical quality and patient safety while expanding access in hundreds of communities, though it has faced legal and regulatory scrutiny over billing practices and service-line decisions. Its goal is to stabilize and improve the financial and clinical performance of underperforming hospitals so they can continue serving their communities.

Company size
5,001-10,000
Company stage
Debt Financing
Total funding
$2.2B
Headquarters
Ontario, CA
Founded
2001

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