Nurse Manager, Care Management

Phoebe Putney Health System•Albany, GA

5d•Onsite

About The Position

Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The Manager works collaboratively to build relationships with key internal and external stakeholders; provides education about CM program functions, payer, and regulatory requirements including current trends and potential impact on the department, hospital, or system. Works collaboratively with the Nurse Manager Command Center to ensure the Utilization Plan is met and there are smooth handoffs with medical necessity reviews.

Requirements

Bachelor's Degree in Nursing, Healthcare, or related field (Required)
3 or more years acute care case management (Required)
3 or more years supervisory and leadership experience with minimum of 2-3 years at manager level in comparable setting (Required)
Registered Nurse (RN) with current Georgia license (Required)
Certified Case Manager (CCM), Accredited Case Manager (Required)

Nice To Haves

Master's Degree (Preferred)

Responsibilities

Support Care Management activities in meeting standards consistent with fiscal, regulatory, clinical, and operational requirements including patient satisfaction.
Provide management, support, and mentoring to Care Management staff and Team Leads; assists Care Manager and Social Work staff in anticipating patient needs, prioritizing issues and providing assistance with difficult/complex care and placement needs, potential denial of days, or other related needs.
Assist Central Intake staff with challenging issues and provides appropriate guidance.
Coordinate recruiting, hiring, and training of new staff; supports ongoing staff development and competencies; provides in-services and education in new requirements and initiatives.
Assess compliance with policies and procedures; performs auditing functions and evaluates designated staff performance.
Resource to physicians and other hospital staff regarding care management activities and changes.
Work collaboratively with the Chief Utilization Officer to identify and manage high-risk and long-stay patient issues, address regulatory changes that impact physician practice, CM, and hospital operations; develop physician education regarding changes in payer and regulatory requirements.
Support the CUO with Utilization Steering Committee coordination, preparation, agenda issues, and presentations.
Maintain current with relevant Federal, State, and local laws, DNV standards, or regulatory agency requirements pertinent to responsibilities.
Assists Director CM to ensure compliance with all such laws and regulations.
Effectively manages budgets and resources to achieve favorable targets; works with Director and designees to prepare annual budgets and monitors expenses and staffing are within budget.
Mentor and supervise the Team Leads; performs evaluations of direct reports and supports growth, job experience and satisfaction.
Support Care Management goals, objectives, performance metrics, and outcomes.
Successfully applies tools of performance improvement/LEAN to achieve efficiency and effectiveness of CM department-related work activities.
Utilize available department and hospital computer systems to develop or refer to for management reporting and performance monitoring related to staff productivity, length of stay, resource utilization, clinical documentation outcomes, bed management activities, transition planning and transitions of care, denials, and related department compliance functions.
Assist the Director with reporting related data outcomes and performance.
Utilize hospital systems and internal licensed software to evaluate use and patterns by staff as well as outcomes relevant to internal department functions for CM, D/C planning, Clinical Documentation, patient access, and throughput; identify patterns or trends and provides recommendations for initiatives and/or changes in practice.
Demonstrate leadership in support of Mission, Vision, and Values; serves as a positive change agent through relationships, engagement, and team building.
Support Director in building relationships with key stakeholders including physicians, nursing, clinical and ancillary departments, and PPHS affiliates.
Set a professional example for staff and Team Leads, carries out functions with a collaborative spirit, and takes initiative to address identified issues; offers recommendations to Director C M or others appropriate to the issue.
Participate in related community service and fosters participation by staff.
Demonstrate positive behavior and sets expectations of staff to promote a positive patient experience and satisfaction.
Foster a collaborative work environment for staff and builds teamwork and positive culture.
Support staff and Team Leads in addressing issues or conflict within and outside the department.
Adheres to the hospital and departmental attendance and punctuality guidelines.
Performs all job responsibilities in alignment with the core values, mission and vision of the organization.
Performs other duties as required and completes all job functions as per departmental policies and procedures.
Maintains current knowledge in present areas of responsibility (i.e., self education, attends ongoing educational programs).
Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs. For non-clinical areas, has attended training and demonstrates usage of age- specific customer service skills.
Wears protective clothing and equipment as appropriate.