Care Manager Jobs

About The Position

Requirements

• Licensed Registered Nurse with a BSN or equivalent.
• At least one year of acute hospital experience as a direct care clinician or case manager, and at least one year of non-hospital-based health care experience, such as home care, insurance, or outpatient care.
• Previous experience managing staff or leading a successful large-scale project implementation, with demonstrated leadership potential.
• Computer skills and critical thinking skills.
• Knowledge of DRGs, Medicare regulations, medical necessity criteria, the Patient Bill of Rights, and HIPAA.
• Knowledge and skills in human resource management; program evaluation using subjective and objective data; market assessment and strategic planning; leadership for change, change management, and operational improvement; assessment and implementation of clinical systems; identification of at-risk populations and development of strategies to manage them; use of clinical software; collaboration; proactive and energetic work; and technical writing for reports, letters, and proposals.
• Maintain department-specific competencies, including age-specific competencies, as developed and reviewed by responsible managers.
• Unless certification, licensure, or registration is required, an equivalent combination of education and experience that provides proficiency in the areas of responsibility may be substituted for the stated requirements.

Nice To Haves

• Master’s degree or equivalent.
• ACM-RN or CCM certification.
• CMAC (Certification as a Case Management Administrator).

Responsibilities

• Conduct Long Stay/Complex Care Rounds with the Physician Advisor and follow up on key next steps within 24 hours.
• Participate in Complex Rounds for patients with long lengths of stay and follow up on indicated next steps.
• Develop effective relationships with Physician Advisors and other physician leaders across services and specialties.
• Provide consultation to the executive team and, as requested by the Director, keep the Director, VPs, and department heads informed about regulatory issues, health care and policy reform, and payer behaviors.
• Participate in defining and periodically evaluating a Case Management Dashboard, using data to assess hospital and department strengths and weaknesses and inform needs, decisions, and strategies.
• Provide effective communication systems and forums with third-party payers, the local PRO/QIO, Medical Records, and Managed Care and finance offices.
• Help create and manage interventions for unforeseen regional, community, and internal hospital crises.
• Manage department software and arrange training as needed.
• Create yearly, weekly, and daily schedules in compliance with the MNA contract; keep personnel informed of staffing and scheduling changes and adjustments needed to meet department goals.
• Work with the Director to develop formal growth or change plans for employees as needed.
• Conduct staff meetings and assist with internal department committees and projects.
• Manage stable and reliable processes to anticipate and address situations within the department, across departments, and with external agencies.
• Participate in case management professional networks and attend conferences aligned with personal learning needs and health system interests.
• Direct and supervise assigned personnel, including performance evaluations, scheduling, orientation, and training; recommend personnel actions and resolve grievances and other personnel problems within the role's responsibilities.
• Develop and recommend budgets for managed areas and manage activities to meet financial goals.
• Coordinate task assignments, help resolve technical and operational problems, and evaluate whether solutions achieve goals.
• Provide direction, guidance, and leadership to promote teamwork and motivation and integrate staff efforts with system-wide initiatives.
• Support diverse views and approaches, demonstrate Standards of Respect, and foster a professional, respectful, tolerant, civil, and accepting environment for employees, patients, and visitors.
• Integrate diversity into departmental objectives, including hiring, promotions, training, and vendor selections.
• Participate in performance improvement initiatives and apply quality improvement in daily operations.
• Ensure compliance with regulatory agencies, including Joint Commission and DPH, and develop and maintain procedures to meet regulatory requirements.
• Ensure departmental compliance with hospital policies, quality assurance programs, and safety and infection control policies and procedures.
• Ensure adequate department equipment and supplies.
• Develop and maintain departmental policies, procedures, and objectives.
• Ensure compliance with health and safety regulations and requirements.
• Maintain regular, reliable, and predictable attendance and perform similar or related duties as required or directed.

Benefits

• A signing bonus may be available; eligibility will be confirmed by a Recruitment Team member during the interview process.