Manager - Case Management RN
About The Position
The Manager for Hospital Case Management is a registered professional nurse and case management expert responsible for planning and overseeing daily operations and developing the case management team. The role partners with physician leaders and other care team members to coordinate clinical care and utilization management. The manager oversees initial and continued-stay level-of-care reviews using approved criteria, discharge coordination to support quality care and financial outcomes, and denials and appeals across the health system. The manager supervises staff and operations, including human resource management, new-staff orientation, competency monitoring and development, policy development, performance evaluations, and developmental planning. The role also supports the implementation and ongoing development of the case management program, promotes contemporary standards of practice, and works with clinical and operational partners to assess outcomes and improve performance.
Requirements
- Registered professional nurse.
- At least 5 years of clinical nursing experience.
- At least 3 years of case management experience.
- Working knowledge of clinical care coordination, discharge planning, community resources, utilization management, quality review standards, third-party payer activities, and regulations.
- Ability to organize and prioritize workload to meet deadlines.
- Excellent interpersonal skills for interacting with healthcare providers, support staff, and third-party payers.
- Demonstrated leadership capabilities and education skills.
Nice To Haves
- Previous supervisory and team development skills are strongly preferred.
Responsibilities
- Provide clinical and case management expertise, operational support, and oversight and supervision of hospital case management functions.
- Assist the Director with recruitment and hiring, and build collaborative relationships with key constituents across departments.
- Support staff accountability and development in care coordination, resource management, discharge planning, utilization management, and department productivity.
- Participate in daily rounds, patient care meetings, and reviews of cases with prolonged length of stay as needed.
- Evaluate level-of-care cases with the Denials and Appeals Coordinator and individual case managers.
- Lead the team as a change agent and professional role model in adopting a comprehensive case manager role focused on care coordination, medical management, and utilization management.
- Partner with the AD to implement InterQual and risk-severity assessment.
- Work with the CM educator to provide staff education, mentor staff, and present in-services on identified or requested topics.
- Support staff regarding HINN, ABN, IM, MOON, level-of-care, and regulatory requirements for discharge facilitation, care coordination, and utilization.
- Obtain national certification and work with the team toward certification over the next 12–24 months.
- Work with the CM educator to update, develop, and maintain yearly programmatic competency requirements and ensure staff compliance.
- Observe and assess staff performance, provide timely feedback, conduct annual performance reviews, and coordinate competency-based orientation.
- Collaborate across teams to assess clinical, utilization, and financial outcome data and evaluate innovative solutions to improve results.
- Assist in creating a case management performance dashboard.
- Assist the Director in leading change and executing the strategic plan for a contemporary case management model, including program development and integration with other clinical services.
- Research best practices and assist the Director in developing or updating departmental policies to reflect contemporary practice.
- Identify prospective candidates from varied healthcare backgrounds and interview and hire staff in partnership with the Director.
- Identify appropriate patients for complex care rounds and coordinate weekly rounds with key stakeholders.
- Partner with physician leaders, nursing, and other colleagues to identify care management and post-acute care transition options.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
