Manager Case Management

Job Requirements

General Summary:

Assumes 24 hour accountability for managing the functions of Care Coordination and Discharge Planning. Along with the Manager of Utilization Management, serves as the central resource to the Director of Care Management to develop financial reimbursement strategies which are efficient, effective, timely and patient-centered. Responsible for meeting accountabilities of the Care Management Dashboard. Collaborates with all disciplines, departments, payers, system partners, vendors, and community agencies to optimize clinical outcomes within best practice, ethical, legal, and regulatory parameters.

Principal Responsibilities and Tasks:

The following statements are intended to describe the general nature and level of work being performed by staff assigned to this classification. They are not to be construed as an exhaustive list of all duties.

1. Direct oversight of the Case Management Lead(s) and Case Management staff.
2. Completes annual and interim performance reviews for all staff and contributes to performance reviews of other professionals and support staff as requested. Develops a growth plan for each employee.
3. Manages hiring and performance management of staff.
4. Keeps key statistics and participates in the maintenance of the Care Management Dashboard, using data to better understand strengths and weaknesses of the hospital and department, and to determine needs, decisions, and strategies.
5. Manages, and constantly evaluates staffing levels, assignments, skills, learning needs, and deployment of staff.
6. Manages structures and processes to facilitate participation by physicians, rehabilitation, pastoral care, social work, and other health professionals in multidisciplinary care planning, care delivery, and discharge planning.
7. Participates and fosters performance improvement within the department and organizationally.
8. Manages the operational budget.
9. Partners with physicians and the Physician Advisor (s) for effective relationships with physicians, services, specialties, etc.
10. Facilitates investigation of patient care issues/complaints.

Knowledge, Skills and Abilities

1. Knowledge of managed care, discharge planning, utilization, case management and social work is required.
2. Highly effective verbal and written skills are required.
3. Strong communication skills, self confidence and experience dealing physicians required.
4. Excellent analytical and team building skills, as well as the ability to prioritize and work independently is required.
5. Must possess the ability to work collaboratively with other disciplines.
6. Ability to work with Hospital/Care Coordination related software programs required.
7. Ability to demonstrate knowledge and skills necessary to provide care appropriate to the patient population(s) served. Ability to demonstrate knowledge of the principles of growth and development over the life span and ability to assess data reflective of the patient's requirements relative to his or her population-specific and age specific needs.

Patient Safety:

Ensures patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives.

1. Takes action to correct observed risks to patient safety.
2. Reports adverse events and near misses to appropriate management authority.
3. Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.

Education and Experience:

1. Bachelor's Degree in nursing or other related health care field required.
2. Master's Degree preferred or an equivalent combination of education and experience in business, nursing or a related allied health field.
3. Five (5) years experience in Care Coordination (acute/post-acute/ambulatory) with demonstrated proficiency of all related skills and knowledge base, including electronic programs, regulatory requirements, payor requirements, related risk management issues, discharge information.
4. Previous experience in progressive leadership or successful project implementation.

Additional Information:

1. All your information will be kept confidential according to EEO guidelines.
2. Work Schedule: M-F 8a-4:30p, 24/7 accountability / weekend coverage as needed

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