Manager Care Management RN

About the role

The Manager Case Management is responsible for the daily management and organization of all activities and staff within the Case Management Department including care coordination, case management, discharge planning, utilization management, social work services, and pre-admission case management.

Responsibilities

• Direct all Case Management department activities, including but not limited to direct supervision of RN Case Managers, Social Workers and support staff.
• Provides ongoing performance feedback, a yearly written evaluation and identification / implementation of staff training needs.
• Provides guidance to case managers to determine suitability for level of care based on community standard as well as published admission and continued stay criteria.
• Coach’s staff in finding alternative levels of care when appropriate as well as alternate payment rates when a denial is eminent.
• Is mindful of fiscal impact to the hospital in decision-making.
• Oversees, improves and troubleshoots processes associated with appropriate patient discharge.
• Led interdisciplinary efforts to address complex patient discharge issues.
• Supports staff and department by sharing case management duties during times of high volume, low staffing and new and / or problem prone processes.
• Identifies variances in patients, processes and systems. Takes immediate and appropriate action to rectify variances with emphasis on collaboration with direct care providers.
• Continually collects and analyzes system and patient data to determine the effectiveness of the Case Management Program including staff and patient satisfaction measures.
• Ensures the proper documentation of all departmental activities and documentation for regulatory compliance.
• Develops and implements policies, procedures, protocols and standards that improve quality of service with measurable performance outcomes.
• Actively leads and supports process improvement activities to further enhance efficiencies and service levels.
• Develops and maintain professional relationships with community providers to promote effective coordination of care across the continuum of services.
• Maintains current working knowledge of community resources.
• Oversees the organization and development of continuously updated reference resource materials.
• Develops operational budget and institutes financial controls and measurement tools.
• Is accountable for personnel, operating and capital budgets for the department.
• Develops strong collaborative relationships with multidisciplinary staff and providers to develop clinically effective strategies such as evidence based clinical pathways and protocols to support and achieve the healthcare goals of the patient.
• Establishes effective mechanisms to support medical management related to utilization of resources throughout the organization.
• Participates as a member or leader of various performance improvement teams related to resource utilization, compliance, reimbursement and medical management.
• Remains current on reimbursement mechanisms and regulatory agency regulations and ensures all staff (including physicians) is updated.
• Counsels and educates the medical staff regarding the Case Management program and processes.

Requirements

Required Qualifications:

• Bachelor's Degree in Nursing or degree in a health related field
• Washington Registered Nurse License
• 6 years of experience in Case Management
• 2 years of Supervisory/management experience, preferably in Case Management
• Nursing experience within a variety of complex client care areas
• Experience and skills in problem-solving and conflict resolution
• Experience in providing adult education to multi-disciplinary staff

Preferred Qualifications:

• Master's Degree in Nursing or a healthcare related field
• Certified Case Manager (CCM) or Accredited Case Manager (ACM)
• Case Management and supervisory/management experience in an acute care hospital

Qualifications

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.