Manager - Care Management - Multiple Locations

Mercy Health • Defiance, OH

1d

About The Position

The Manager, Care Management oversees the day-to-day operations, coordination, organization, and resources of the Care Management Department. The role works with Care Management leadership and colleagues to standardize assigned functions and combines clinical and financial considerations to support optimal outcomes for patients and the organization.

The manager leads the Care Management Team and supports practices and processes for advance care planning, length-of-stay management, readmission prevention, predictive readmission tools and interventions, denial prevention, progression of care, barrier and avoidable-day tracking, daily team rounding, care transitions, and patient satisfaction related to transitions. The role monitors qualitative and quantitative results and takes action to address barriers and improve outcomes.

The position promotes appropriate care, at the appropriate time and place, and educates care management staff, physicians, nurses, and other care team members on care progression, level of care, and safe and timely transitions. It supports national care management scope-of-service standards, including education, care coordination, compliance, transition management, and resource utilization.

The manager uses departmental systems to support proactive care management across the continuum and partners with population health, community health, ambulatory, and post-acute providers and staff to support patient-centered care and seamless transitions. The role partners with a physician leader on the Utilization Management Committee and provides actionable data about utilization opportunities.

The manager directs daily staffing and resource operations, helps develop departmental goals and strategic plans, and builds collaborative relationships across nursing, quality, hospitalist, physician advisor, and other physician leadership teams. The position participates in annual budget development and management, identifies cost reductions, supports standardization, and works with colleagues and stakeholders to reduce costs while understanding the financial effects of contracts and payment-model changes.

Requirements

• Bachelor of Science in Nursing or Social Work.
• Three years of recent acute hospital care management experience.
• Skills and knowledge in care management, discharge planning, patient advocacy, care planning, and care coordination.
• Ability to analyze data or information and knowledge of reimbursement methodologies.
• Knowledge of staffing workflow, bed allocation, clinical matters, tracking, and 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; required for RSFH.
• Flexible.

Responsibilities

• Lead and oversee the day-to-day operations of the Care Management Team.
• Coordinate standardized practices for advance care planning, length-of-stay management, readmission prevention, use of predictive readmission tools, denial prevention, care progression, barrier and avoidable-day tracking, daily team rounding, care transitions, and transition-related patient satisfaction.
• Monitor qualitative and quantitative performance data and take action to mitigate 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, nurses, and other care team members about care progression, level of care, and safe, timely transitions.
• Support care management standards for education, care coordination, compliance, transition management, and resource utilization.
• Use departmental systems to support proactive care management across the continuum and align efforts with population health and community health initiatives.
• 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 personnel operations in accordance with patient and ministry needs.
• Assist with developing annual departmental goals and objectives aligned with system goals, and help develop strategic plans and initiatives.
• Foster collaboration with nursing, quality, hospitalist, physician advisor, and other physician leaders to support clinical integration and high-quality, cost-efficient care.
• Participate in development and management of the annual budget and identify and achieve cost reductions.
• Work with colleagues and stakeholders to standardize operations and reduce costs, while understanding the financial impact of contracts and changing payment models.

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