Case Management Manager

Case Management Nurse Director

The Case Management Nurse Director evaluates and ensures that hospital resources are used appropriately and effectively. The Director oversees the collection, analysis, and reporting of financial and quality data related to utilization management, quality improvement, and performance improvement. The Director is accountable for achieving established performance targets through actively engaging multiple disciplines and professional staff. The Director must appropriately manage people relationships and processes in order to achieve maximized results. The Director ensures that the department achieves its goals and objectives by engaging internal and external stakeholders in care management processes at Boston Medical Center. The Director promotes interdisciplinary collaboration, fosters teamwork, and champions service excellence.

Essential Responsibilities/Duties:

• In collaboration with the health care team directs, coordinates, supervises, and provides clinical care to patients.
• Develops and sustains a practice environment that supports evidence-based clinical practice through planning and implementing programs that contribute to positive patient outcomes.
• Promotes integration of evidence-based research into practice at the unit level.
• Assures appropriate care delivery model considering the skill mix necessary to provide quality care and fluctuations in unit(s) activity and acuity levels.
• Collaborates with the interprofessional team to develop, revise, and update clinical priorities and care management plans.
• Sets priorities for appropriate and efficient management of patient care that reflects cost-effective management of time available human resources, supplies, and equipment.
• Maintains knowledge of regulatory and accreditation standards and ensures compliance.
• Maintains knowledge of patient safety and implements the hospital’s Quality and Safety Plan through the timely and accurate completion of review of RL incident reports, conducting follow-up investigations, and initiating corrective action as needed.
• Communication and Relationship-Building: The Nurse Director utilizes expert communication strategies that facilitate productive relationships with others within the organization and influences employee behavior.
• Interviews, hires, trains, supervises, evaluates performance, and implements corrective actions as necessary and seeks feedback and guidance as appropriate and according to established personnel policies and procedures.
• Ensures that hiring and supervising practices and promotion recommendation actively support the organization’s affirmative action and equal opportunity policy.
• Actively embraces, engages, and promotes diversity, equity, and inclusion activities.
• Acquires, maintains, and utilizes knowledge of current labor contracts and personnel policies and procedures for all clinical staff.
• Works collaboratively with Human Resource/Labor Management staff as needed.
• Initiates timely and appropriate management interventions inclusive of coaching, counseling, and progressive discipline for the clinical staff.
• Conducts independent investigation of employee incidents involving clinical practice issues including review of employee personnel file, discipline record, and evaluations.
• Imposes appropriate disciplinary action as needed.
• Utilizes data from staff engagement surveys to develop action plans and improve outcomes.
• Embraces recognition and reward tactics.
• Recommends employees for promotion or other incentives/programs/rewards.
• Evaluates probationary employees’ work performance and recommends employment continuation or discharge.
• Employs and encourages interprofessional communication and collaboration to positively impact patient safety, teamwork, and achievement of strategic goals.
• Is accessible and visible using a variety of communication strategies, regular staff meetings, daily huddles, and leader rounding.
• Leadership: As a transformational leader, the Nurse Director views issues globally, creates a vision of what might be, inspires others, tolerates chaos and ambiguity, does not fear taking risks, and works with others in a more connected way.
• Participates in strategic planning to establish departmental goals and metrics, cascade goals to the unit, and work to achieve organizational goals.
• Communicates departmental goals to the staff and fosters a work environment that motivates employees to achieve these goals.
• Fosters a culture of shared governance inspiring others to be involved in unit-based councils, departmental councils, implementation of evidence-based practices, innovation, and quality improvement activities.
• Establishes unit-based goals for quality and satisfaction metrics, educational progression, and specialty certification and encourages staff participation in professional organizations.
• Utilizes the performance appraisal process as a tool to seek feedback, encourage growth, inspire others, and establish and achieve individual goals.
• Embraces the Magnet culture enculturating the tenets of a Magnet organization at the unit level and contributes to the development of the Magnet document and preparation for site visit.
• Participates as a committee member and/or chairperson when requested.
• Professionalism: The Nurse Director consistently demonstrates the BMC core values to achieve optimal outcomes in patients, workforce, and communities by wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability.
• The Nurse Director empowers others to demonstrate accountability, values, and ethical concepts in decision making and patient care.
• Embraces the BMC Nursing Professional Practice Model and communicates the impact of model on nursing department core values and patient care practices.
• In collaboration with the interdisciplinary team analyzes systems trends and variances and implements strategies to improve outcomes.
• Serves as a resource/mentor to staff regarding professional development encouraging continuing education, formal study, and individual learning opportunities as appropriate.
• Provides the tools and feedback to staff to grow and develop as professionals.
• Identifies opportunities for quality improvement by evaluating the efficiency and cost-effectiveness interprofessional and interdepartmental efforts collaboratively identifying, implementing, and evaluating strategies to improve systems and monitoring the outcomes of interventions, quality, and patient and staff satisfaction outcomes.
• Identifies own learning needs and assumes responsibility for maintaining current knowledge, competency, and expertise in area of specialty.
• Assures completion of annual mandatory educational requirements e.g., safety review, infection control standards, departmental/specialty competencies and maintains appropriate credential status for self and direct reports.
• Business Skills: The Nurse Director understands the business aspects of healthcare and is intimately involved in the financial and administrative aspects of the facility.
• Assists in the development and monitoring of annual financial goals for area of responsibility.
• Assists in the evaluation of results relating to resource utilization before and after planned changes occur.
• Assists in the planning and implementation of strategies to improve cost-benefit for patient care and workflow.
• Collaborates with appropriate departments to assure that clinical documentation is complete, accurate, and maximizes reimbursement and external reporting requirements.
• Other duties as required.

Job Requirements:

• Education: The Nurse Director is a Registered Nurse who holds a master’s degree or will receive a master’s degree within 6 months of hire. Either the master’s degree or baccalaureate degree must be in nursing.
• Certificates Licenses Registrations Required: CCM, ACM, or related certification preferred. Licensed to practice professional nursing as a Registered Nurse in the Commonwealth of Massachusetts in good standing required. Professional certification preferred required within 2 years of hire.
• Experience: A minimum of 5 years clinical experience. Previous management experience within a utilization management/case management department or other cost/quality program.

Compensation Range: $153,000.00-$222,000.00

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes but is not limited to benefits (medical, dental, vision, pharmacy) discretionary annual bonuses, and merit increases. Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.

Note: This range is based on Boston-area data and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

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