Manager Inpatient Care Management

The Manager, Inpatient Care Management manages staff performance and costs to plan/target, while working to improve the quality of patient care delivery. Collaborates closely with nursing partners to influence plan of care. They ensure the provision of ongoing and reliable information related to the continuum of care and discharge planning, ensuring that information is compliant with regulatory requirements and sensitive to member benefit coverage.

Essential Job Function:

• Accountable and responsible for inpatient care management team with matrixed responsibility for utilization review nurses.
• Oversees case managers, social workers, and other team members.
• Serves as the primary accountable party for patient progression in the hospital setting.
• Works collaboratively to manage and drive an appropriate length of stay and discharge disposition for inpatients, provide collaboration with UR nurses to ensure concurrent assessment of InterQual or Milliman criteria for admission in the emergency departments, daily review of medical necessity, and wrap around services for our vulnerable populations.
• Leads progression rounds and ensures documentation is completed.
• Responsible for day-to-day operations through direct reports.
• Oversees the care management functions across the acute care footprint in accordance with policies and procedures as well as federal, state and local regulations.
• Manages the day-to-day patient flow and care coordination within the acute care space, ensuring effective, efficient delivery of care, safe and timely discharges to the various post-acute care settings - namely that patients receive the right care, in the right venue at the right time within regulatory requirements.
• Collaborate and align with our post-acute network partners and VBCI leaders to ensure movements into and from our post-acute network are seamless and patient centric.
• Leads discipline accountable for daily progression rounds and documentation.
• Holds accountability for regulatory compliance in areas of oversight and fiscal responsibility for those areas.
• Continuously monitors metrics and data to be sure we are providing the highest quality of care at the lowest possible cost.
• Other duties as assigned.

Education:

• Required: Bachelor's degree in Nursing or Business.
• Preferred: Master's degree in Nursing, Social Work, or Business.

Experience:

• Required: Minimum 3 years of experience managing in a health care setting, preferable including utilization management, case management, and/or social work experience.

Licensure/Certification/Listing:

• Strongly Preferred: Current ACM-RN or CCM certification.

Required

Preferred

Job Industries

• Other