RN Manager, Jewish Hospital, Care Management

UofL Health•Louisville, KY

4d•Onsite

About The Position

Under the direction of the Director of Care Coordination, the Manager, Care Management supports the daily operation of the Care Coordination Department and promotes optimal patient outcomes in accordance with UofL Health policies, procedures, applicable laws and contracts, and the organization’s philosophy, mission, vision, and values. The manager is the main driver of facility length-of-stay and readmission outcomes and helps ensure compliance with regulatory agencies and third-party payers. The role requires working knowledge of finance, reimbursement, payers, community resources, accreditation standards, quality improvement, clinical care, and board-based organizational issues. The manager uses planning, organizing, directing, and controlling to guide decisions; maintains confidentiality; supports organizational goals; and works effectively across staff levels while managing multiple tasks and changing priorities. Work hours may be adjusted according to departmental and organizational needs as determined by the director. The position leads and develops the care management team, supports appropriate clinical resource use and care transitions, monitors performance and operational processes, and collaborates with clinical and financial staff to advance patient, quality, and financial goals. It also serves as a resource to physicians and staff on clinical management, reimbursement, documentation, and compliance matters.

Requirements

Registered Nurse with a Bachelor of Science in Nursing (BSN).
Five years of experience as a Care Manager or Utilization Review Nurse.
Unrestricted Registered Nurse license in Kentucky.
Current Basic Life Support-CPR certification.
Strong organizational, interpersonal, and communication skills.
Attention to detail, ability to organize multiple tasks, and ability to adjust priorities quickly.
Innovative problem-solving skills and ability to work interdependently with staff at multiple levels.
Working knowledge of finance, reimbursement, third-party payers, community resources and agencies, accreditation standards, quality improvement, and clinical care.
Knowledge of state laws, CMS conditions of participation, and TJC standards related to care management and discharge planning.
Must be able to adjust work hours based on departmental and organizational needs, as determined by the director.

Nice To Haves

Master’s degree in Nursing, Business, Health Care Administration, or equivalent.
Two years of acute hospital experience.
Case Management certification (ACM, ANCC-Nurse Case Manager, or CCM).

Responsibilities

Oversee timely initial admission assessments using clinical indicators and anticipated service needs, readmission risk assessments, referrals to ancillary and post-acute services, recommendations for appropriate hospital level of care, and validation of patient demographics and payer source.
Assist in developing policies and procedures that support compliance with regulatory, ethical, legal, and accreditation standards.
Develop monitoring and tracking systems to improve data collection related to length of stay, readmissions, use of hospital ancillary services, and reimbursement.
Ensure ongoing development and documentation of multidisciplinary clinical assessments by RN Care Managers, and monitor staff participation in daily unit Rapid Rounds.
Monitor and maintain PTO requests in SmartSquare according to Care Coordination PTO guidelines.
Lead staff in a manner consistent with hospital philosophy and sound business principles; motivate staff, support team cohesiveness, encourage education and certification, and serve as a professional role model.
Enter, verify, and approve payroll in Kronos on a bi-monthly basis.
Evaluate technology, resources, and tools and recommend improvements to processes, systems, and revenue.
Participate in professional organizations and stay current with developments in the field.
Represent the department in leadership activities, including committees, accreditation preparation, and meetings.
Collaborate with clinical and financial staff to meet hospital financial goals; monitor reimbursement changes and patterns and take action to resolve issues.
Work with the director and staff to develop departmental goals that support the hospital’s mission and direction.
Pursue professional growth and maintain competency in care management principles through education, literature, in-service meetings, and workshops.
Support patient satisfaction goals and use appropriate service-recovery tools and services.
Contribute to organizational metrics and goals that support the organization’s financial security.
Advocate respectfully, impartially, and confidentially for patient and family needs.
Educate physicians, patients, and staff about payers, financial issues, documentation, and potential compliance issues.
Serve as a resource to physicians on clinical management and financial issues; help providers improve care-delivery efficiency and reduce barriers to effective services.
Use sound nursing judgment, demonstrate problem-solving initiative, work effectively with others, and adhere to the professional code of conduct.
Promote departmental goals for quality, patient outcomes, and resource conservation through value-enhancement activities.
Maintain knowledge of state laws, CMS conditions of participation, and TJC standards applicable to care management and discharge planning.
Comply with company policies, procedures, standards of conduct, and HIPAA privacy and security requirements.
Attend specialty service-line case conferences and staff meetings.
Maintain an active, unrestricted Kentucky RN license and current Basic Life Support-CPR.