Manager, Case Management & Social Services

Bay Area Hospital•Fort Bridger, WY

1d•Onsite

About The Position

The Manager of Case Management & Social Services provides operational and clinical leadership for Case Management, Social Services, discharge planning, utilization management, transitions of care, and related care coordination activities. The Manager is responsible for ensuring effective, patient-centered care coordination across the continuum while supporting safe and timely transitions of care, appropriate utilization of healthcare resources, regulatory and payer compliance, and achievement of organizational quality, financial, and patient experience goals. This position leads an interdisciplinary team responsible for identifying and addressing barriers to care and discharge, coordinating complex patient needs, supporting appropriate level-of-care determinations, and connecting patients and families with appropriate healthcare and community resources. The Manager collaborates closely with physicians, nursing leadership, Quality, Revenue Cycle, Compliance, Risk Management, community providers, post-acute care organizations, and other members of the healthcare team to improve patient outcomes and facilitate efficient movement of patients through the continuum of care.

Requirements

Demonstrated knowledge of acute-care case management, social services, discharge planning, utilization management, transitions of care, and healthcare reimbursement principles.
Strong leadership skills with demonstrated ability to coach, develop, engage, and hold employees accountable.
Knowledge of CMS requirements, Conditions of Participation, payer requirements, medical necessity, patient status, and regulatory standards applicable to case management and discharge planning.
Demonstrated ability to analyze clinical and operational data, identify trends, and lead performance improvement initiatives.
Strong critical-thinking, problem-solving, conflict-resolution, and decision-making skills.
Ability to effectively manage complex patient care and discharge issues involving multiple clinical, psychosocial, financial, and community considerations.
Strong interdisciplinary collaboration skills and ability to build effective relationships with physicians, clinical leaders, patients, families, payers, post-acute providers, and community organizations.
Excellent verbal, written, presentation, and interpersonal communication skills.
Ability to prioritize multiple responsibilities and adapt effectively to changing operational and patient-care needs.
Proficiency with electronic health records, utilization/case management systems, Microsoft Office applications, and other healthcare information systems.
Maintains regular, consistent, and punctual attendance at the assigned job location
Bachelor’s degree in Nursing, Social Work, Healthcare Administration, or another healthcare-related field required.
Current, unrestricted professional licensure appropriate to discipline when required by the position and scope of practice required.
Minimum five (5) years of progressively responsible experience in case management, utilization management, social services, care coordination, discharge planning, or a related acute-care healthcare setting preferred.
Minimum three (3) years of demonstrated leadership, supervisory, or management experience.
Ability to remain in a stationary position and perform computer-based and administrative work for extended periods, with frequent walking throughout hospital and clinical areas.
Ability to communicate effectively in person, electronically, in writing, and by telephone with patients, families, employees, physicians, community partners, and other healthcare professionals.
Requires sufficient visual acuity, hearing, manual dexterity, and fine motor coordination to operate computers, phones, and standard office and clinical communication equipment.
Ability to maintain concentration, exercise sound judgment, prioritize competing demands, and make timely decisions in a fast-paced healthcare environment involving complex or sensitive situations.
Ability to occasionally bend, reach, stoop, and lift or carry office materials and equipment generally weighing up to 25 pounds.
Work is performed primarily in an office and acute-care hospital environment and may involve occasional exposure to infectious diseases, blood or bodily fluids, emotionally stressful situations, and other healthcare-related occupational hazards; adherence to applicable safety practices and standard precautions is required.

Nice To Haves

Master’s degree preferred.
Certification in Case Management, such as CCM, ACM, or equivalent nationally recognized certification, preferred.
For nursing candidates, current Oregon Registered Nurse license or ability to obtain Oregon licensure preferred.
For social work candidates, applicable Oregon social work licensure or credentialing appropriate to assigned responsibilities preferred.
Experience in an acute-care hospital environment strongly preferred.
Demonstrated experience leading interdisciplinary teams, managing complex discharge planning needs, and implementing performance improvement initiatives preferred.

Responsibilities

Provides daily operational leadership and oversight for Case Management, Social Services, utilization management, discharge planning, and care coordination functions.
Recruits, selects, develops, supervises, and evaluates department employees in accordance with hospital policies and leadership expectations.
Establishes clear performance expectations and monitors employee performance, productivity, competency, and professional development.
Recognizes employee strengths, provides timely coaching and feedback, and develops performance improvement plans or corrective action when appropriate.
Promotes a collaborative, accountable, patient-centered work environment consistent with Bay Area Hospital’s Behavioral Standards.
Identifies department education and competency needs and collaborates with Clinical & Professional Development and other resources to provide appropriate education and training.
Serves as a subject matter resource and provides guidance to staff regarding complex cases, discharge barriers, utilization concerns, patient/family needs, and escalation processes.
Oversees the development, implementation, and ongoing evaluation of effective case management, social services, utilization management, discharge planning, and transitions-of-care processes.
Ensures early identification and proactive management of barriers that may delay treatment, progression of care, discharge, or transition to the next appropriate level of care.
Promotes interdisciplinary care planning and effective collaboration among physicians, nursing, therapy, pharmacy, behavioral health, social services, post-acute providers, patients, families, and other members of the healthcare team.
Supports effective management of complex patient populations, including patients with significant medical, behavioral health, psychosocial, financial, housing, transportation, caregiver, or post-acute care needs.
Ensures patients and families receive appropriate education, resources, referrals, and support necessary for safe and effective transitions of care.
Develops and maintains collaborative relationships with skilled nursing facilities, home health agencies, hospice providers, behavioral health organizations, community agencies, payers, and other post-acute and community partners.
Supports processes intended to reduce preventable readmissions, avoidable delays, unnecessary utilization, and gaps in transitions of care.
Provides oversight of utilization management activities to support appropriate patient status, medical necessity, level of care, and efficient use of hospital resources.
Ensures Case Management and Social Services practices comply with applicable CMS Conditions of Participation, state and federal requirements, payer requirements, accreditation standards, and hospital policies.
Supports processes for timely utilization review, patient status evaluation, required patient notices, discharge planning evaluations, and documentation.
Collaborates with physicians, physician advisors, and other stakeholders to address utilization, authorization, medical necessity, and payer-related issues.
Monitors regulatory and industry changes affecting case management, utilization management, discharge planning, social services, and transitions of care and incorporates changes into department practices as appropriate.
Develops, reviews, and maintains department policies, procedures, workflows, and competencies consistent with evidence-based practices and regulatory requirements.
Establishes, monitors, and evaluates department performance measures and uses data to identify opportunities for improvement.
Monitors key indicators such as length of stay, avoidable days, discharge delays, readmissions, utilization trends, discharge disposition, denials, and other organizationally identified measures.
Collaborates with Quality and clinical leadership to ensure department activities support hospital-wide quality, patient safety, and performance improvement priorities.
Leads or participates in interdisciplinary initiatives designed to improve patient flow, transitions of care, discharge efficiency, resource utilization, and patient outcomes.
Incorporates patient and family feedback into improvement efforts and promotes communication, education, and coordination practices that support a positive patient experience.
Uses performance data, benchmarking, trends, and root-cause analysis to identify opportunities and implement sustainable process improvements.
Develops, manages, and monitors department budgets, staffing plans, productivity, and resource utilization.
Evaluates staffing requirements based on patient volume, acuity, workload, organizational priorities, and regulatory requirements.
Identifies opportunities to improve operational efficiency while maintaining appropriate quality, safety, and service standards.
Collaborates with hospital leadership regarding staffing, resources, technology, and other operational needs affecting Case Management and Social Services.
Provides reports, analysis, and recommendations to leadership regarding department performance, utilization trends, discharge barriers, and opportunities for improvement.
Performs other duties as assigned.