The Supervisor of Outpatient Case Management supports the Director of Outpatient Case Management in the overall management and oversight of Regal's Outpatient Care Management Programs. This role is responsible for developing, implementing, and monitoring department projects, and ensuring compliance with program requirements, contractual obligations, the Case Management Model of Care, and all quality and regulatory standards.
The Supervisor provides coaching and oversight to staff, monitors productivity, and ensures timely care coordination for enrollees who are high‑risk for disease progression, clinical decline, or urgent/emergent needs.
This position supports daily program operations and collaborates closely with the concurrent review team, inpatient and SNF care teams, home health providers, home visit program staff, hospice agencies, and the pre‑authorization department. Effective partnership with Network Management, Finance, and Claims is also required. The Supervisor oversees processes related to ambulatory case management, including standardized documentation, auditing, quality initiatives, and programs that support appropriate resource utilization within member benefits and contracted services. The role works collaboratively with other Medical Management departments to promote optimal clinical outcomes, appropriate utilization, quality patient care, and high enrollee satisfaction.
Essential Duties and Responsibilities include the following:
- Supervises staff and manages enrollees assigned to Outpatient Case Management programs to ensure efficient and timely delivery of care, timely referrals, and progression of treatment plans through the care continuum.
- Develops, monitors, and analyzes program and department reports and identifies trends to improve clinical, utilization, and quality outcomes.
- Collaborates with RMG Medical Directors to review data and implement programs that improve enrollee outcomes.
- Develops a standardized process for triaging and enrolling appropriate members into Outpatient Case Management programs.
- Identifies and develops program and department policies and procedures and ensures compliance and consistency across all RMG regional sites.
- Develops and coordinates strategies to ensure delivery of care in the most cost‑effective setting.
- Serves as a resource for outpatient case management staff, utilization management staff, other departments, home health agencies, and home visit providers.
- Motivates, instructs, mentors, audits, and leads staff to continually improve service quality and clinical outcomes.
- Develops annual program and department goals and objectives focused on improving patient outcomes and operational efficiency.
- Implements tools and processes that promote a high level of customer service for enrollees.
- Works collaboratively with the Medical Management team to ensure company goals are met and compliance with regulatory and health plan requirements is maintained.
- Provides direct oversight and accountability for program and department case management and ancillary staff.
- Trains, mentors, and audits staff to ensure clinical competency, productivity, contribution, and quality customer service; serves as a resource to all program and department staff.
- Provides regular audit reports on program and department staff and develops action plans to improve efficiency and effectiveness.
- Supervisor's service area, jurisdiction, and responsibilities may be expanded or changed at the employer's discretion and in consultation with the Vice President of Outpatient Case Management.
- Performs additional responsibilities as mutually agreed upon with the Vice President and/or Director of Outpatient Case Management.
- Performs all other duties as directed by management.
The pay range for this position at commencement of employment is expected to be between for Supervisor RN's $130,000.00 Annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards, in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, the employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest-growing Independent Physician Associations in California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming, and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Full-Time Position Benefits:
The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness:
Employer-paid comprehensive medical, pharmacy, and dental for employees
Vision insurance
Zero co-payments for employed physician office visits
Flexible Spending Account (FSA)
Employer-Paid Life Insurance
Employee Assistance Program (EAP)
Behavioral Health Services
Savings and Retirement:
4401 (k)Retirement Savings Plan
Income Protection Insurance
Other Benefits:
Vacation Time
Company celebrations
Employee Assistance Program
Employee Referral Bonus
Tuition Reimbursement
License Renewal CEU Cost Reimbursement Program
Business-casual working environment
Sick days
Paid holidays
Mileage
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
Requirements:
Education and/or Experience:
- Previous supervisory and management experience required.
- Experience managing high‑risk cases required.
- Active California RN license required; CCM certification preferred.
- Strong knowledge of case management processes and principles.
- Prior experience in an MSO environment preferred.
- Ability to work effectively with all levels of management.
- Excellent verbal and written communication skills required.
- Strong organizational skills required.
- Experience with project development and implementation required.
- Proficiency in Microsoft Office required.
- Current California driver's license and proof of auto insurance required.
Compensation: $130,000.00
