This position is responsible for establishing departmental goals and objectives consistent
with the mission and goals of the organization, selecting and retaining qualified staff, and
maintaining efficient work processes to meet the needs of all the stakeholders.
ESSENTIAL DUTIES AND RESPONSIBILITIES
1. Manages the daily operations of the Ambulatory Care Department to meet
turnaround times and other requirements as defined by the scope of the contracts and
utilization and quality expectations for these programs. In conjunction with the Supervisor
and the Medical Director, the Manager:
a. Establishes and communicates staff performance standards.
b. Uses daily management reports and system queries to assess turnaround time and other
key performance indicators. Implements changes in daily assignments and performance
expectations as required.
c. Ensures appropriate staffing levels and individual staff assignments to meet
d. Is available and approachable to staff for problem solving and for daily direction and
e. Ensures that the staff has appropriate resources to perform expected duties and that
Practice Connect rules and desktop reference information are current and accurate.
f. Collaborates with the Medical Director on specific cases and regarding changes in
department goals and policies.
g. Observes workflow and outputs. Identifies and modifies unproductive and/or
inefficient work processes.
h. Ensures appropriate communication and exchange of information between MHC and the
i. Establishes work and communication processes that foster maximum collaboration
among department staff, other PWL departments, care management programs and network providers.
j. Provides members and physicians with access to ACM staff for information about the
UM process and authorization of care.
k. Provides continuous feedback to the Director of Care Management to support efforts to
improve department efficiency, patient care management, communication and data collection and
2. Responsible for maintaining and enhancing auto approval of referral authorizations.
a. Reviews daily statistics regarding the number of incoming referrals and the percent of
referrals that auto approved. Investigates sudden changes in statistics by reviewing detailed
reports of referrals that did and did not auto approve. Works with the Supervisor of
Ambulatory care Management to identify and resolve problems.
b. Reviews daily status 7 reports to identify additional referrals that should be auto
approved. Develops auto approval clinical rules. Obtains approval from the Medical Director
to implement the rules.
c. Reviews error reports regarding auto approvals submitted by the staff to the
Supervisor and monitors problem investigation and resolution.
3. In collaboration with the trainer, develops and implements staff education programs to
assure high quality consistent service to all stakeholders and regulatory compliance.
a. Educational programs include but are not limited to the following areas:
· EZ Cap
· Practice Connect
· Referral authorization workflow and processes
· Prioritizing and processing current day’s referral authorizations
· Appropriate referral documentation
· Regulatory requirements
· Goals of the organization and the Care Management Department
· Use of desktop resources
b. Provides one-on-one mentoring and feedback to staff regarding work quality and
identifies needs for additional training.
c. In conjunction with the trainer, performs periodic retrospective review of a sampling
of each staff’s work to monitor the quality and consistency of decision-making and compliance
with established policies and procedures.
d. Develops expertise in use of EZ Cap software. Attends and/or assigns specific staff
to attend EZ Cap user group meetings in order to remain knowledgeable regarding system
functionality and new applications.
4. Provides direction for the Care Management Department, if assigned, in the
absence of the Director.
NON-ESSENTIAL FUNCTIONS: Attendance at routine meetings
· Manages exempt and non-exempt employees.
· Responsible for the overall direction, coordination and evaluation of these
· Performs supervisory responsibilities in accordance with the organization’s policies
and applicable laws.
· Interviews, hires and trains employees.
· Plans, assigns and directs work.
· Establishes individual staff goals and performance standards and uses these to
evaluate staff performance.
· Rewards and disciplines employees.
· Addresses employee complaints and resolves problems.
EDUCATION and/or EXPERIENCE:
California RN License; 5-7 years clinical RN experience: 5 years supervisory/management