Manager - Care Management - St. Rita's Medical Center

Mercy Health • Lima, OH

1d

About The Position

The Manager, Care Management oversees the day-to-day functions and resources of the Care Management Department at St. Rita's Medical Center. The role coordinates department operations and works with Care Management leadership and colleagues to standardize practices. It combines clinical and financial considerations to support patient outcomes and organizational goals.

The manager leads Care Management staff and processes across the continuum, including care progression, utilization management, discharge and transition planning, readmission prevention, denial prevention, and resource utilization. The position collaborates with physicians, nursing, quality, hospitalists, population and community health teams, and ambulatory and post-acute providers to support coordinated, high-quality, cost-efficient care.

The role also contributes to departmental goals, strategic plans, staffing and budget management, and cost-reduction efforts. It uses qualitative and quantitative data to evaluate performance, identify barriers and utilization opportunities, and improve outcomes. The position is scheduled for 40 hours per week on days/afternoons.

Requirements

• Bachelor of Science in Nursing or Social Work.
• At least 3 years of recent acute hospital care management experience.
• Skills in care management, discharge planning, patient advocacy, care planning, and care coordination.
• Ability to analyze data or information and track relevant measures.
• Knowledge of reimbursement methodologies, staffing workflows, bed allocation, and clinical practices.
• Working knowledge of local and state resources.
• Knowledge of government and non-government payer practices, regulations, standards, and reimbursement.
• Leadership, mentorship, employee training, and knowledge-sharing abilities.
• Attention to detail, critical thinking, communication with family members, conflict resolution, and a proactive approach.

Nice To Haves

• Master's degree in Nursing, Social Work, or Healthcare Administration is preferred for BSMH; it is required for RSFH.

Responsibilities

• Lead and oversee the day-to-day operations of the Care Management Team.
• Work with Care Management leadership and colleagues to standardize practices and processes for advance care planning, length-of-stay management, readmission prevention, predictive readmission tools and interventions, medical-necessity denial prevention, care progression, avoidable days and delays, team rounding, care transitions, and patient satisfaction related to transitions.
• Monitor qualitative and quantitative data, address barriers, and take appropriate action to improve outcomes.
• Advocate for and educate others about providing the right care, at the right time, in the right place.
• Educate care management staff, physicians, nurses, and other care team members about care progression, level of care, and safe, timely transition management.
• Support national care management standards in education, care coordination, compliance, transition management, and resource utilization.
• Use Care Management Department systems to support proactive care management across the continuum and align with population health and community health efforts.
• Collaborate with ambulatory and post-acute providers and staff to support seamless care transitions.
• Partner with a physician leader to optimize the Utilization Management Committee and provide actionable data on utilization opportunities.
• Direct daily operations and personnel resources according to patient and ministry needs.
• Assist with developing annual departmental goals and objectives aligned with system Care Management goals, and assist with strategic departmental plans and initiatives.
• Build collaborative partnerships with nursing, quality, hospitalists, physician advisors, and other physician leaders to support clinical integration and high-quality, cost-efficient care.
• Participate in developing and managing the annual budget, identify and achieve cost reductions, and work with colleagues and stakeholders to reduce costs.
• Support standardization of operations and understand the financial impact of contracts and changes from fee-for-service to value-based care.

Benefits

• Competitive pay, incentives, referral bonuses, and a 403(b) with employer contributions when eligible.
• Medical, dental, vision, and prescription coverage; HSA/FSA options; life insurance; mental health resources; and discounts.
• Paid time off, parental and FMLA leave, short- and long-term disability, and backup care for children and elders.
• Tuition assistance, professional development, and continuing education support.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager