Manager, Care Management

Summary

The Manager of Care Management provides operational leadership and oversight of the Care Management Department, ensuring the delivery of safe, efficient, and patient-centered care. This position focuses on the day-to-day management of discharge planning, care coordination, and case management staff, while supporting compliance with CMS Conditions of Participation (CoPs), DNV accreditation standards, and ACMA best practices.

Leadership and Oversight

• Provides day-to-day leadership for Care Management staff.
• Implements departmental policies, procedures, and workflows to ensure efficient patient care and safe transitions.
• Oversees staff assignments, scheduling, and resource allocation to meet departmental and organizational goals.
• Makes decisions regarding length of stay, discharge delays, avoidable days, and readmissions, escalating issues to the Director as needed.
• Supports departmental readiness for internal and external audits, quality reviews, and compliance monitoring.

Staff Development and Performance

• Recruits, trains, and evaluates Care Management team members; conducts performance appraisals and corrective actions as appropriate.
• Supervises and evaluates Care Management staff; provides coaching, feedback, and corrective action as needed.
• Ensures orientation, competency validation, and ongoing education for staff in discharge planning, care coordination, and patient advocacy.
• Promotes a culture of professionalism, accountability, and collaboration across the Care Management team.
• Supports the Director in implementing continuous staff development programs aligned with CMS, DNV, payer, and ACMA standards.

Collaboration and Communication

• Coordinates daily discharge planning rounds and barrier resolution activities, escalating complex or high-risk cases to the Director.
• Communicates effectively with Nursing, Medical Staff, Therapy, Ancillary Departments, and post-acute providers to facilitate timely transitions of care.
• Provides education and guidance to staff and other hospital departments on case management processes, regulatory requirements, and community resources.
• Maintains accurate and timely documentation of case management activities in hospital software systems.

Operational and Quality Improvement

• Makes decisions regarding key departmental metrics and prepares reports for the Director of Care Management as requested.
• Aids in implementing process improvement initiatives to enhance patient flow, reduce readmissions, and improve patient satisfaction.
• Safeguards staff compliance with CMS CoPs, DNV standards, and hospital policies for care management documentation and processes.

Supervisory Responsibilities

• Reports to: Director of Care Management
• Supervises: Registered Nurse and Social Work Case Managers
• Responsibilities: Day-to-day operations of the Care Management Department, staff supervision, and process execution.

Education and Experience

• Bachelor of Science in Nursing (BSN); Master’s preferred.
• Minimum of three (3) years of acute care case management experience required.
• At least one (1) year of leadership experience preferred, including supervisory, lead, or senior-level responsibilities in a healthcare or case management setting.

Licenses and Certifications

• Active Registered Nurse (RN) license in the Commonwealth of Virginia required.
• Certification as an Accredited Case Manager (ACM) or Certified Case Manager (CCM) required.