Manager - Case Management - FT - Days - MHP

Memorial Healthcare•Pembroke, MA

1d•Onsite

About The Position

Assumes 24-hour accountability for managing the functions of Access, Care Coordination, and Discharge Planning. With the Manager - Social Work, serves as the central resource to the Director - Case Management to develop strategies which are efficient, effective, timely, patient-centered, and support appropriate financial reimbursement. To meet accountabilities of the Care Management Dashboard, collaborates with all disciplines, departments, payers, system partners, vendors, and community agencies to optimize clinical outcomes within best practice, ethical, legal, and regulatory parameters.

Requirements

Accredited Program: Nursing (Required)
Registered Nurse Compact License (RN LICENSE COMPACT) - Compact RN Multistate, Registered Nurse License (RN LICENSE) - State of Florida (FL)
Minimum of three (3) years of case management experience
At least two (2) years of leadership experience within case management.
Understanding of payer guidelines
Critical thinking and effective communication (verbal and written) skills
Decisive judgment
Ability to work with minimal supervision
Ability to work in a stressful environment and take appropriate action
Knowledge of State and Federal regulations governing discharge planning conditions of participation
Knowledge of hospital information systems (e.g., logician and IDX)
Knowledge of staff development techniques
Knowledge of performance improvements processes
Strong background in clinical decision making
Strong background in medical criteria
Strong background in discharge planning
Proficient with Interqual or Milliman guidelines and use.
Proficient in process improvement
Proficient in performance monitoring.

Nice To Haves

Certification in Case Management preferred.
Graduate of an accredited Registered/Professional Nursing program or a Bachelor’s degree in Nursing (BSN).

Responsibilities

Assists with the preparation and evaluation of departmental budgets, and ensures that the department operates in compliance with allocated funding.
Coordinates and directs internal/external audits.
Monitors staffing activities, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
Completes annual and interim performance reviews for all staff and contributes to performance reviews of other professionals and support staff as requested.
Manages and constantly evaluates staffing levels, assignments, skills, learning needs, and deployment of staff.
Assists with the management and evaluation of department operations, including information technologies, service level determination and complaint management, to achieve performance and quality control objectives.
May collect and assess data to identify quality trends or actual sources of risk to patients and employees.
Collaborates with multi-disciplinary teams and committees with respect to quality outcomes.
Participates in clinical performance improvement activities, including the development of clinical paths, patient/family education programs, collaborative practice groups, Six Sigma, and other quality initiatives.
Assists with the development and implementation of Case Management goals, plans, and standards consistent with the clinical, administrative, regulatory, legal, and ethical requirements.