Supervisor Care Management, Registered Nurse

Promotes the achievement of optimal clinical and resource utilization allocation, facilitates appropriate lengths of stay and reimbursement for all hospital admissions in accordance with goals and objectives.

Responsibilities

• Oversees the discharge/transition planning executed by the Care Management staff, and audits said activities for accuracy of delivery.
• Conducts weekly Clinical-Financial meetings to monitor patients with high dollar, high LOS and/or social barriers.
• Collaborates with multidisciplinary team to problem solve for these cases.
• Works knowledge of regulatory requirements and insurance coverage/limitations as it relates to care delivery in the acute setting and transitioning to the non-acute setting.
• Participate in weekly meetings with new employees and Preceptor during orientation phase to evaluate the staff progress and adjust plans accordingly.

Requirements

• Minimum Qualifications:
  • Bachelor’s Degree in Nursing or Master’s Degree in Social Work
  • Current licensure as required by state board where services will be provided: Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC)
  • Licensed Graduate Social Worker (LGSW) through the West Virginia Board of Social Work
  • Licensed Certified Social Worker (LCSW) through the West Virginia Board of Social Work
  • Licensed Independent Clinical Social Worker (LICSW) through the West Virginia Board of Social Work
  • Five (5) years of Nursing or Medical Social Work experience (two (2) of which are inpatient hospital setting)
  • Two (2) years of Care Management or supervisory experience

Preferred Qualifications

• Care Management Certification

Core Duties and Responsibilities

• Oversees the discharge/transition planning executed by the Care Management staff, and audits said activities for accuracy of delivery.
• Conducts weekly Clinical-Financial meetings to monitor patients with high dollar, high LOS and/or social barriers.
• Collaborates with multidisciplinary team to problem solve for these cases.
• Working knowledge of regulatory requirements and insurance coverage/limitations as it relates to care delivery in the acute setting and transitioning to the non-acute setting.
• Participate in weekly meetings with new employees and Preceptor during orientation phase to evaluate the staff progress and adjust plans accordingly.
• Serves as a resource and role model for department personnel.
• Serves on various hospital committees as needed or assigned.
• Educates hospital staff and physicians to payer regulations and managed care principals to ensure seamless patient care.
• Fosters the integration of staff and/or students into the healthcare team.
• Improves and maintains management skills by participating in self-development activities such as seminars, workshops, classes and literature review.

Physical Requirements

• Prolonged walking, standing, or sitting may be required

Working Environment

• Patient care environment
• Flexible hours to include weekends and holidays

Skills and Abilities

• Excellent interpersonal communication and negotiation skills in interactions with patients, families, physicians, and healthcare team colleagues
• Ability to work with people of all social, economic, and cultural backgrounds and be flexible, open minded, and adaptable to change
• Demonstrates expert team building skills, problem solving abilities, and conflict resolution strategies