Manager - Care Management - Multiple Locations

Mercy Health BSMH • Tiffin, OH

2d

About The Position

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

The manager leads care management operations and staff, supports effective and timely care progression and transitions, and works across the care continuum with clinical teams, physicians, ambulatory and post-acute providers, and community partners. The position also supports utilization management, departmental planning and budgeting, resource use, and cost reduction. The role is listed for Tiffin Hospital, Defiance, and Willard.

Requirements

• Bachelor of Science in Nursing or Social Work.
• BLS Basic Life Support certification from the American Heart Association.
• 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 proactive skills.

Nice To Haves

• Master's degree in Nursing, Social Work, or Healthcare Administration (preferred for BSMH; 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 license preferred in Virginia.

Responsibilities

• Lead and oversee 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, avoidable-day tracking, daily team rounding, care transitions, and patient satisfaction related to care transitions.
• Monitor outcomes using qualitative and quantitative data, address barriers, and take action to improve results.
• 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 progression of care, level of care, and safe, timely transition management.
• Support national 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 with population health and community health efforts.
• Collaborate with ambulatory and post-acute providers and staff to ensure seamless transitions of care.
• Partner with a physician leader to optimize the Utilization Management Committee and provide actionable data on utilization opportunities.
• Direct daily operations and personnel resources in accordance with patient and ministry needs.
• Assist with developing annual departmental goals and objectives aligned with system Care Management goals, as well as strategic 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 collaborate with staff and stakeholders to reduce costs.
• 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