Case Management Supervisor

Prime Healthcare•Evanston, IL

2d•Onsite

About The Position

The working Supervisor of Case Management is responsible for providing supervision to the Social Worker Case Managers, RN Case Managers, UR Tech, and Discharge Planners; as well as working with the facility Medical Review Coordinator (MRC) on all cases of Peer to Peer review, outcomes and initial appeal requests. The Case Management Supervisor provides oversight for the quality and resources management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record to assure all parameters for MCG/Milliman criteria/InterQual which includes the medical overview to find medical necessity, intensity of service and severity of illness.

Requirements

Licensed clinician in your state
At least one-year experience in case management, discharge planning or management
Experience and knowledge in basic to intermediate computer skills

Nice To Haves

CCM or obtained within 1year
Minimum 5 years of acute care experience
Current BCLS certificate preferred
Knowledge of Milliman Criteria and InterQual Criteria preferred

Responsibilities

Providing supervision to the Social Worker Case Managers, RN Case Managers, UR Tech, and Discharge Planners
Working with the facility Medical Review Coordinator (MRC) on all cases of Peer to Peer review, outcomes and initial appeal requests
Providing oversight for the quality and resources management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management
Working on behalf of the advocate, promoting cost containment
Demonstrating leadership to integrate the health care providers to achieve a seamless delivery of care
Facilitating and insuring the achievement of quality, clinical and cost effective outcomes
Performing a holistic and comprehensive admission and concurrent review of the medical record to assure all parameters for MCG/Milliman criteria/InterQual which includes the medical overview to find medical necessity, intensity of service and severity of illness