Manager - Care Management - St. Elizabeth Youngstown Hospital

Mercy Health BSMH • Youngstown, OH

6d

About The Position

The Manager, Care Management oversees the day-to-day operations, coordination, organization, and resources of the Care Management Department at St. Elizabeth Youngstown Hospital. The role combines clinical and financial considerations to support optimal patient and organizational outcomes and works with Care Management leadership and colleagues to standardize practices and processes.

The manager leads Care Management staff and supports effective progression of care, utilization management, denial prevention, readmission prevention, length-of-stay management, advance care planning, and safe, timely transitions. The position uses qualitative and quantitative data to monitor performance, identify barriers, and improve outcomes. It also provides education to staff and clinical partners, collaborates across the continuum with ambulatory and post-acute providers, and supports patient-centered care management aligned with population and community health efforts.

The role partners with physician leadership to optimize the Utilization Management Committee and uses data and analytic resources to identify utilization opportunities. It directs personnel resources, contributes to departmental goals and strategic plans, supports collaboration across clinical teams, and participates in annual budget development and management, cost reduction, and operational standardization. The manager is expected to understand the financial implications of contracts and the shift from fee-for-service to value-based care.

Requirements

• Bachelor of Science in Nursing or Social Work.
• BLS Basic Life Support certification from the American Heart Association.
• Current RN license in the state of practice or Social Worker license in the state of practice.
• Three years of recent acute hospital care management experience.
• Skills in care management, discharge planning, patient advocacy, care planning, care coordination, data analysis, reimbursement methodologies, staffing workflow and bed allocation, clinical knowledge, tracking, and knowledge of local and state resources.
• Knowledge of government and non-government payer practices, regulations, standards, and reimbursement.
• Leadership, mentorship, employee training, knowledge sharing, 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 and required for RSFH.
• Accredited Case Manager (ACM) certification from the American Case Management Association, Certified Case Manager (CCM) certification from the Commission for Case Manager Certification, or ANCC Nursing Case Management board certification.
• Social Worker licensure is preferred in Virginia.

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, progression of care, barrier resolution, avoidable-day tracking, daily team rounding, care transitions, and patient satisfaction related to transitions.
• Monitor qualitative and quantitative performance data and take action to address barriers and 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, nursing, and other care team members about progression of care, level of care, and safe, timely transition management.
• Support national care management standards covering 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 ensure seamless care transitions.
• Partner with a physician leader to optimize the Utilization Management Committee and provide actionable data about utilization opportunities.
• Direct daily operations and personnel resources in alignment with patient and ministry needs.
• Assist with developing annual departmental goals and objectives aligned with system Care Management goals, as well as 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 and identify and achieve cost reductions.
• Work with colleagues to standardize operations and with staff and stakeholders to reduce costs.
• Understand the financial impact of contracts and changing payment models 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