Care Management Manager

Job Requirements

General Summary: Manages the daily operations of the department to include Care Management, Discharge and Transition Planning, and Utilization Management in accordance with regulatory requirements and the needs of the organization. Assumes responsibility for optimal clinical and financial outcomes across provider lines and systems in conjunction with all members of the healthcare team.

Principal Responsibilities And Tasks

• Serves as a resource for the staff providing expertise and guidance with regard to clinical activities.
• Maintains a consistent environment where employees are encouraged, reinforced, and supported in their desire to contribute fully.
• Makes recommendations for personnel transfer, promotion, and specialized training to insure effective utilization of individual skills and employee development.
• Maintains ongoing communication with staff to maintain institutional and departmental goals and encourages staff participation and communication in decision-making.
• Makes recommendations for personnel transfer, promotion, and specialized training to insure effective utilization of individual skills and employee development.
• Maintains knowledge base to present accurate/current information.
• Effectively participates in the development, revision, implementation, and communication of policies and procedures and standards for the staff in accordance with hospital and department policies and procedures.
• Monitors reasons for reduction in patient satisfaction, re-admission and discharge appeals and reports trends to the Director.
• Diplomatically negotiates with diverse groups of people in an exchange of information to provide regular reports.
• Assists to create, develop and trend reports of care management; collaborates with the Director to analyze and presents findings to leadership.
• Collaborates with director in administrative planning and program development activities.
• Maintains an effective, organized care management program and interdepartmental programs that assure compliance with federal and state regulatory policies for hospital services of various regulatory agencies (PRO, Joint Commission, CMS and Department of Health and Mental Hygiene).
• Provides ongoing information to the Director regarding the programs, department, hospital wide activities, screening elements, communication from regulatory agencies and identified problems as appropriate.
• Functions as a representative of the Care Management Department with Administration and external agencies as requested by the Director.
• Identifies opportunities for improvement in hospital systems, care provider practice patterns, patient/family/staff satisfaction, and resource utilization.

Education and Experience

• BS in Nursing (Required);
• Master’s Degree (Preferred);
• Minimum 5 years Case Management experience, which includes at least 2 years progressively responsible supervisory experience.