Manager of Case Management

Heywood Hospital•Gardner, MA

12d

About The Position

As a member of the Heywood Healthcare Family, The Manager of Case Management is responsible for the provision of service for Case Management, Social Service, and Utilization Management for Heywood Healthcare (Heywood and Athol Hospital. Oversight includes the Swing Bed Program in conjunction with the Swing Bed Coordinator at Athol Hospital, a critical access hospital. The Manager will provide leadership, direction, and support for discharge planning, social work, utilization review, cost-effectiveness, accountability, and best practice. The Manager will work collaboratively with community and internal stakeholders.

Requirements

BSN required or must matriculate within 1 year of hire; MSN preferred.
Registered nurse required with an active Massachusetts license
Previous management experience required
Five or more years of case management experience
Minimum 3 years of Acute Care Inpatient Case Management experience required
Previous UR/QA experience required
Must have effective written, verbal, and interpersonal communication skills
Discharge planning experience as it pertains to the care transitions, referral process, patient preference/choice services, patient & family satisfaction, post-discharge follow-up, etc.

Nice To Haves

Case Management Certification preferred
InterQual experience preferred.
leadership experience a plus.

Responsibilities

Provides coaching and education for staff so that they can meet/exceed performance expectations, such as: Develop and implement performance improvement plans in collaboration with the Director. Provide constructive feedback to employees. Ensures that employee skills match job requirements. Completes all employee performance evaluations by evaluation due dates.
Oversees daily operations to meet the vision of providing service to the community, such as: Improves patient and/or customer satisfaction. Responds to customer requests and concerns in a timely and effective manner. Meets/exceeds customer expectations so that the customers select and recommend Heywood Hospital as their primary source of healthcare, such as: Utilizes customer satisfaction data to develop and anticipate customer service systems. Staffing patterns and work flow design match customer requirements.
Manages resources to ensure adequate resources and future growth, such as: Develops and maintains department budget in conjunction with the Director. Monitors OT and justifies variances to the budget. Review and approval payroll weekly. Interviews, hires, and onboarding new staff. Reduces costs and/or increases revenues.
Collaborates/coordinates projects/activities with other departments, teams, and task forces to build a team approach to healthcare delivery, such as: Participates on task forces, PI teams, committees, etc. Leads task forces, PI teams, committees, etc.
Acts as a resource for the care transitions department.
Demonstrates the clinical expertise necessary to perform as a role model for staff. Provides feedback to staff during daily rounds concerning: level of care, ABN/HINN notices, and care progression.
Lead and direct all case management and social services activities, ensuring patient care coordination and adherence to clinical protocols and regulatory standards.
Reviews department clinical services and operations, and tracks case management and social services activity. Identifies areas for performance improvement by examining productivity and workload within each department. Coaches, mentors and assesses staff in service delivery.
Develops and implements Utilization Review based on internal data collection, data received from external agencies, physician advisors and the medical director. Analyzes appropriateness of resource utilization and communicates findings.
Maintains necessary levels of staff qualifications, competencies, staffing levels, regulatory compliance, individual development plans, continuing education and performance appraisal.
Manages resource use and provides input to Director regarding expense and revenue decisions. Monitors outcomes and staffing needs to adequately allocate personnel resources.
Ensures department achieves goals and objectives by developing scope of service and policies/procedures, establishing/maintaining effective relationships with physicians/APPs, and collaborating with other disciplines. Assesses goals and utilizes data to effect corrective action.
Ensures appropriateness of admissions and proper reimbursement. Works collaboratively with finance.
Ensures proper discharge planning for a smooth transition post-acute care.
Reviews and presents data relative to avoidable days, denials, length of stay and other key metrics to leadership.
Perform internal audits to ensure compliance with organizational and state/federal practices, policies, and regulations.
Assists Director with developing and/or revising policies and procedures to comply with regulations and best practice.
Other duties as assigned.