Clinical Operations Supervisor - Transitions of Care

$92,000 - $154,545/Yr

Whidbey Island Public Hospital - Coupeville, WA

Full-time - Manager

Coupeville, WA

Executive, Legislative, and Other General Government Support

About the position

The Transitions of Care Supervisor is a full-time position responsible for ensuring compliance with CMS Conditions of Participation regarding Utilization Review, Discharge Planning, and social work. The supervisor will oversee the process and, at times, complete assessments to identify patients' clinical needs and construct care plans. This role integrates utilization review, discharge planning, and resource management to ensure care is provided in the most appropriate setting, improving quality through coordination of care, impacting length of stay, minimizing costs, and ensuring optimum outcomes. The supervisor will oversee a team of case managers and social workers, coordinating efforts, monitoring quality of care, and implementing strategies to meet organizational goals. The position requires exceptional clinical judgment, time management, and communication skills.

Responsibilities

• Oversee the daily operations and workflow of case managers and social work.
• Develop, implement, and review policies and procedures to enhance the quality of case management services.
• Facilitate regular team meetings to discuss case progress, challenges, and strategies for improvement.
• Allocate caseloads and assignments to case managers and social workers.
• Liaise with external agencies, stakeholders, and service providers to coordinate resources and services for clients.
• Manage and resolve complex cases and client issues that are escalated by the Transitions team.
• Prepare and analyze reports on case management activities, outcomes, and service utilization.
• Collaborate in the implementation of Transitions of care management policies.
• Manage communication within the Transitions of care team.
• Assist manager in the development and execution of monthly schedule and timecard management.
• Address departmental and interdepartmental issues as needed.
• Maintain knowledge of current trends in Transitional care management nursing.
• Communicate with patients and their family members, offering emotional support.
• Assess, process, and discharge patients in accordance with policies and procedures.
• Maintain patient confidentiality and adhere to HIPAA regulations.
• Provide a direct line of communication between patients, nursing staff, and physicians.
• Perform pre-admission status recommendation reviews.
• Complete initial needs assessments when a patient is admitted.
• Contact discharged patients within 24 hours for follow-up.
• Ensure appropriate patient status upon admission and manage status conversions.
• Complete admission medical necessity reviews within 24 hours of admission.
• Identify and escalate Medicare IP stays and collaborate with Care Management team.
• Communicate with payers regarding status changes and authorizations.
• Participate in clinical performance improvement activities and utilization review committee.
• Support the organization's vision, mission, and values.
• Deliver customer service and/or patient care in a timely and efficient manner.

Requirements

• Graduate of an accredited school of nursing, BSN preferred.
• Minimum 5 years' experience as an RN, with two years in utilization review, case management, or discharge planning.
• Experience using MCG or InterQual Criteria preferred.
• Experience using clinical documentation for payment resolution recommendations.
• Ability to construct and document a succinct clinical summary.
• Must be able to work as an independent problem solver.
• Excellent interpersonal and communication skills.

Nice-to-haves

• Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred.
• MCG Certification preferred.

Benefits

• Benefit eligible for employees working 0.5 FTE or higher.