Regional Operations Manager

Requisition ID
2017-2065
# of Openings
1
Category
Operations
US-CA-Santa Monica

Overview

 

The Regional Operations Manager (ROM) is responsible for the overall success and quality of case management services and for the coordination of medical care, vocational exploration, counseling and job placement services. This position monitors individual work product, provides education and training to assigned case managers, ensures respective staff are providing superior customer service and providing claimants with the highest level of support and assistance to regain maximum medical improvement and sustain regular employment. This position ensures compliance with all company practices and URAC Standards.

Responsibilities

 

ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:

  • Developing, implementing, monitoring and evaluating measurement tools as needed to ensure ongoing standards of quality and turnaround times are being met.
  • Discussing with VP case management operations when additional case managers are needed in order to ensure case volume is adequately maintained.
  • Determining who is available to take assignments and notifying the referral coordinators of availability.
  • Educating, providing resources/guidance, and interacting with the case managers, referral coordinators and the billing department on a regular basis.
  • Managing turnaround time of work product completed by assigned case managers.
  • Conducting new hire orientation for all new case managers and providing ongoing support.
  • Reviewing and approving case management reports on a daily basis.
  • Reviewing billing activity in conjunction with report documentation to assure accuracy.
  • Researching pertinent WC statutory information and updating/modifying resource database accordingly.
  • Responding promptly to customers and account executives regarding work product concerns.
  • Participating in weekly   Quality and Operations conference calls with peers and senior management as required to address improvement opportunities or operational deficiencies.
  • Reporting and evaluating timeliness and QA outcomes of all case management work to the VP, case management.
  • Maintaining quality assurance of all products. Facilitating/overseeing timely delivery of product to customer
  • In conjunction with Home Office, periodically auditing case managers to ensure they are currently performing in accordance with ECS policies and procedure
  • Obtaining/maintaining national certifications as required.
  • Active membership in national and local organizations is encouraged to enhance/maintain company presence (CMSA, IARP, RIMS, etc.)
  • Attending all scheduled conference calls as mandated by management
  • Maintaining any required credentials and adhering to all codes of ethics required by those credentials.
  • Performing various professional duties as assigned.

 

 

SUPERVISORY RESPONSIBILITIES

Directly supervise and carry out supervisory responsibilities in accordance with ExamWorks Clinical Solutions (ECS) policies and applicable laws. Responsibilities include, but are not limited to:

  • Carrying out all managerial responsibilities in accordance with the company’s standards, policies, and all applicable employment laws.
  • Providing support, training, tools, and techniques to assist staff in achieving department goals and standards.
  • Managing new hire orientation, training, and continued employee development.
  • Managing the department’s time off programs and coordinating work schedules as needed.
  • Encouraging positive morale, maintaining harmony among staff, and resolving grievances when needed.
  • In conjunction with the Human Resources Department, has responsibility for the Departments’ hiring and employee separation needs.
  • Communicating change effectively and preparing and supporting those affected by change accordingly.
  • Observing employee performance and documenting performance issues as needed.
  • Supervising staff and when warranted, initiating corrective or disciplinary actions as required.
  • Providing periodic performance feedback and addressing any performance concerns, recommendations for job placement and/or growth opportunities to senior management and the Human Resources Department.
  • Responsibility to successfully complete annual performance evaluations.
  • Ensuring all staffing needs are met and the most effective working environment is achieved.

This person can sit anywhere in Southern California.

Qualifications

  • 5+ years of case management experience and 3+ years of management experience. 
  • Knowledge of the disability and workers' compensation industry including rules and regulations and an understanding of clinical procedures and all processes involved in the delivery of quality health care to an injured worker is preferred.
  • Practicing case management within the scope of his/her licensure (based on the standards of the discipline)Adequately operating a general computer, fax, copier, scanner, and telephone.
  • Having strong knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
  • Possessing knowledge of current laws and regulations that govern delivery of rehabilitation services.
  • Possessing knowledge of human behavior and performance.
  • Ability to demonstrate strong customer service including needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
  • Ability to demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed
  • Must be able to work independently, prioritize work activities and use time efficiently.
  • Ability to concentrate and multitask in a fast paced work environment.
  • Demonstrating accuracy and thoroughness.
  • Looking for ways to improve and promote quality and monitoring own work to ensure quality is met.
  • Maintaining confidentiality.
  • Demonstrating and promoting a positive team-oriented environment.
  • Working well under pressure and/or stressful conditions.
  • Ability to manage change, delays, or unexpected events appropriately.
  • Possession of a valid driver’s license.
  • Provide proof of personal automobile liability insurance with liability limits of no less than Five Hundred Thousand and No/100 Dollars ($500,000.00) per occurrence.
  • Ability to operate a vehicle and willingness to travel for task and/or field case management visits within assigned geographic areas.
  • Possession of excellent English usage, grammar, punctuation and language style.
  • Demonstrating reliability and abiding by company attendance policy.
  • Maintaining a professional and clean appearance at all times consistent with company standards.
  • Bilingual in English and Spanish preferred.  

 

EDUCATION AND/OR EXPERIENCE

  • Associates Degree or Diploma in nursing is acceptable; a bachelor’s degree in nursing and/or health related field preferred and current, active, and unrestricted licensure as a health professional (RN); or
  • A current, unrestricted license or certification to practice a health or human services discipline in a state or territory of the United States that allows the health professional to independently conduct an assessment as permitted within the scope of practice of the discipline.
  • When the individual is in a state that does not require licensure or certification to practice in a health or human services discipline, then the individual must have a baccalaureate or graduate degree in social work, or another health or human services field that promotes the physical, psychosocial, an/or vocational well-being of the persons being served, that requires:
  • A degree from an institution that is fully accredited by a nationally recognized education accreditation organization;
  • The individual must have completed a supervise field experience in case management, health, or behavioral health as part of the degree requirements, and
  • Must achieve a URAC-recognized certification in 4 years of hire as a Case Manager (such as ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, or COHN-S.)

 

CERTIFICATES, LICENSES, REGISTRATIONS

  • Active unrestricted Registered Nursing license with active state nursing license for area of assigned jurisdiction, or

 

  • A current, unrestricted license or certification to practice a health or human services discipline that allows the health professional to independently conduct an assessment as permitted within the scope of practice of the discipline; and
  • URAC-recognized certification in case management within three (3) years of directly supervising the case management process.
  • Where state regulation requires, may be required to obtain and maintain state specific certifications.

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