Manager of Case Management

Prime Healthcare•Olympia Fields, IL

About The Position

The working Manager of Case Management develops the staff and systems needed to operate a comprehensive Case Management Program. The role provides leadership and supervision to case managers, social workers, case management coordinators and discharge planners, utilization review coordinators, and utilization review technicians. The manager assesses needs, plans, communicates, and designs services appropriate to the hospital’s mission and the needs of patients and families. The role integrates and coordinates services using continuous quality improvement tools and is responsible for the quality and resource management of patients admitted to the facility, from admission throughout the continuum of health care management. The program’s methodology is designed to support quality, clinical, and cost-effective outcomes and includes holistic, comprehensive admission and concurrent medical-record reviews for medical necessity, intensity of service, and severity of illness.

Requirements

Licensed clinician in the state of practice; grandfathered prior to April 1, 2015.
For Licensed Clinical Social Workers, at least five years post-graduate experience from an accredited school of Social Work.
At least five years of experience in a Case Management position.
Analytical ability to identify problems and assess and evaluate data and statistics obtained through an ongoing review process.
Basic to intermediate computer skills and knowledge.

Nice To Haves

Certification in Case Management.
BS, BSN, or a degree in a related field.
Current BCLS certificate.
Knowledge of Milliman Criteria and InterQual Criteria.

Responsibilities

Develop staff and systems to operate a comprehensive Case Management Program.
Provide leadership and supervision to case managers, social workers, case management coordinators and discharge planners, utilization review coordinators, and utilization review technicians.
Assess needs and plan, communicate, and design services appropriate to the hospital’s mission and patient and family needs.
Integrate and coordinate services using continuous quality improvement tools.
Manage the quality and resources for patients admitted to the facility, from admission across the continuum of health care management.
Conduct holistic and comprehensive admission and concurrent reviews of medical records for medical necessity, intensity of service, and severity of illness, with the aim of achieving quality, clinical, and cost-effective outcomes.