Manager- Case Management

Reports and works under the direction of the Director of Case Management. Provides leadership for the case management team and oversees the Department's daily activities. Coordinates the department's case management/utilization functions to provide efficient and effective outcome-based patient centered care. Primary responsibilities include, but are not limited to, assigning duties to staff members based on ratios/volumes, skills, and departmental needs, identifying and mitigating problems as they occur, and addressing performance issues. Demonstrates the ability to meet the needs and provide service to all age groups.
Education

• Bachelor's degree in Nursing (BSN) required

Experience

• 3-4 years Relevant acute care work experience required
• 2-3 years of case management experience preferred
• 2-3 years of progressive leadership experience preferred

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure in the District of Columbia or Maryland depending on work location required and
• CCM - Certified Case Manager preferred

Knowledge, Skills, and Abilities

• Effective verbal and written communication skills.
• Excellent interpersonal and customer service skills especially serving geriatric patients.
• Strong analytical and critical thinking skills.
• Strong community engagement and facilitation skills.
• Advanced project management skills.
• Commitment to collective impact concepts.
• Flexibility and the ability to work autonomously as well as take direction as needed.
• Cultural competency.
• Proficient computer skills along with experience using Microsoft applications-Word, Excel, etc. and familiarity with entering data in an electronic medical record (EMR).

Under the direction of the Director of Case Management, manages department staff. Is involved in orientation, training and mentoring and assessing competencies for employees in the Department; and completing annual and interim performance reviews.

Assists with the overall operational direction of the Case Management Program through the integration of social work, utilization management, and case management functions to achieve identified objectives.

Assists in the development and recommendation of department operating budget and ensures that the department operates within the budget

Manages the daily operations of the department by maintaining appropriate staffing levels and assignments. Refers to the current census report at the beginning of the shift and makes staffing changes if warranted. Monitors patient volume/census and case complexity/acuity fluctuations, reassigning staff as appropriate.

Supervises the Case Management Staff in performing utilization review in accordance with guidelines and regulations established by the hospital board, Administration, Medical Staff, accreditation and certification agencies, and Federal and State governments.

Participates in meetings and on committees and represents the department and hospital in community outreach efforts as required.

Establishes and promotes relationships with clinical team members, physician advisor and individual physicians regarding medical necessity, payer related issues and denials management. Contributes to the development of physician strategy as related to documentation and resource management.

Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees, and represents the department and hospital/facility in community outreach efforts as appropriate.

Escalates issues to the department director (e.g., physician, complex cases, legal, regulatory, complaints, risk, safety, patient and family complaints and concerns).

Monitors key performance indicators to ensure that objectives are met. These include clinical assessments of patients for care coordination, utilization management, discharge planning, and post-acute evaluation.

Interfaces with external stakeholders and agencies (e.g., Department of Health, home health agencies, skilled nursing facilities, durable medical equipment agencies) and provides appropriate information, consultation, or recommendations.

Oversees the orientation of all new inpatient case managers by establishing the plan and monitoring progress in conjunction with other staff as necessary.

Orients and/or supervises staff and students as assigned.