Manager of Case Management

Conifer Health Solutions•San Antonio, TX

About The Position

This position may qualify for a sign-on bonus. Responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources balanced with the patient’s resources and right to self-determination. Has overall responsibility to ensure that care is provided at the appropriate level of care based on medical necessity and assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including: Provides assistance to the Director of Case Management in the management of the department, but not limited to, hiring/training/managing staff, schedule coordination, analysis and reporting, interfacing, collaborating and working closely with the other departments; Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction; Care Coordination by demonstrating efficient throughput while assuring care is sequenced and at the appropriate level of care; Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy; Provides education to physicians, patients, families and caregivers; Facilitates education programs for Case Management Department on community resources use in discharge planning that encourages professional growth; Provides reports to DCM and hospital leadership. Completes established competencies for the position within designated introductory period. Other related duties as assigned.

Requirements

Graduate of an accredited School for Nursing
2 years of acute hospital patient care, hospital case management, healthcare or leadership experience.
Demonstrates computer knowledge of programs related to position and displays competency on an ongoing basis.
Possession of current Texas State registration as a Registered Nurse

Nice To Haves

Bachelor’s Degree from accredited college or university for Nursing
Previous Case Management Supervisory experience
Certification in Case Management (CCM)

Responsibilities

Facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources balanced with the patient’s resources and right to self-determination.
Ensure that care is provided at the appropriate level of care based on medical necessity and assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions.
Provide assistance to the Director of Case Management in the management of the department, including hiring/training/managing staff, schedule coordination, analysis and reporting, interfacing, collaborating and working closely with other departments.
Manage Utilization Management supporting medical necessity and denial prevention.
Manage Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction.
Manage Care Coordination by demonstrating efficient throughput while assuring care is sequenced and at the appropriate level of care.
Ensure compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy.
Provide education to physicians, patients, families and caregivers.
Facilitate education programs for Case Management Department on community resources use in discharge planning that encourages professional growth.
Provide reports to DCM and hospital leadership.
Complete established competencies for the position within designated introductory period.
Perform other related duties as assigned.