Manager Case Management

About the role

The Manager Case Management position oversees the human and material resources of the Case Management Department to provide quality patient care and foster a supportive work environment.

Responsibilities

• Strategic Oversight: Develops and implements case management programs, including utilization review, intake, and discharge planning.
• Collaborates with staff to plan unit/patient assignments based on staff education, training, and ability, as well as patient needs.
• Supervises recruitment, interviewing, and selection of unit staff, and conducts performance reviews and counseling/discipline.
• Maintains staff qualifications, including licensure, certification, and registration.
• Evaluates work flow for continuity of patient services, enhancing cost management.
• Monitors case management activities and time-line compliance through case management reports and logs.
• Coordinates the orientation process for new employees.
• Maintains observation, admission, and length of stay data on a monthly basis.
• Manages departmental budgets, expenses, and medical resource usage to enhance cost-effectiveness.
• Fulfills regulatory compliance by ensuring adherence to federal, state, and organizational guidelines, such as Medicare/Medicaid/Commercial requirements and JCAHO standards.
• Facilitates communication regarding patient care by acting as a liaison with the medical staff and resolving patient issues.
• Analyzes patient care data and key care indicators to identify trends, reduce delays, and improve clinical outcomes.
• Ensures patients receive comprehensive assessments and reassessments, psychosocial support, and education for safe discharge.
• Participates in utilization management across the continuum of care and monitors readmissions.
• Coordinates interactions with other healthcare facilities, community agencies, and the public.
• Manages denial management, assuming primary responsibility for the Axis program and overseeing the appeals management process.
• Serves as a liaison with the finance/billing department for claims issues and monitors concurrent and retrospective denials.
• Buys and maintains effective relationships with payers and participates in the UR Committee.
• Demonstrates leadership, direction, and remediation to unit-specific nursing personnel.

Requirements

• Education: Bachelor of Science Degree in Nursing, Social Work, or related Health field required. Master’s Degree preferred.
• Experience: Five years of Case Management experience required. One year supervisory experience required.
• Knowledge, Skills, Abilities: Demonstrated leadership and interpersonal skills; ability to work effectively under stress; strong oral and written communication skills; ability to communicate professionally with patients, physicians, visitors, co-workers, and supervisors; ability to document data and other information; ability to read, write, and speak English; knowledge of human resource laws and regulations; current licensure as a professional registered nurse in Pennsylvania or LMSW/LCSW license preferred; Certified Case Manager (CCM) preferred; meets American Heart Association’s standards for Healthcare Provider Basic Life Support (BLS).

Skills

• Leadership and interpersonal skills.
• Ability to work effectively under stressful situations.
• Strong oral and written communication skills.
• Ability to communicate professionally with patients, physicians, visitors, co-workers, and supervisors.
• Ability to document data and other information.
• Ability to read, write, and speak English.
• Knowledge of human resource laws and regulations.
• Current licensure as a professional registered nurse in Pennsylvania or LMSW/LCSW license preferred.
• Certified Case Manager (CCM) preferred.
• Meets American Heart Association’s standards for Healthcare Provider Basic Life Support (BLS).

Benefits

Details about benefits will be provided upon hire.

Pay

Details about pay will be provided upon hire.

Schedule

The schedule for this position will be provided upon hire.