Supv Care Management

About the Role

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. Acts as a key informational and educational resource liaison for the team. Works to develop organizational approaches to problem solving, analyzes current systems and variances to identify opportunities for improvement, and promotes quality of care through collaboration with all service team members, patients, and families.

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, collaborating with the multidisciplinary team to problem solve for these cases.
• Demonstrates 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.
• Participates in weekly meetings with new employees and Preceptor during orientation to evaluate staff progress and adjust plans accordingly.
• Serves as a clinical resource and role model for department personnel, providing guidance on complex high-acuity patient assessments and interventions.
• Provides timely and comprehensive documentation of interactions with patients/families.
• Assists departmental executive leadership in developing annual competency analysis system requirements and criteria to ensure necessary knowledge, skills, and attitudes.
• Provides constructive and timely feedback to the Manager on employee performance and management.
• Supports an environment for innovation, creativity, and empowerment in care delivery based on current literature and research.
• Promotes and contributes positively to intradepartmental and interdepartmental relationships.
• Serves as a role model and promotes effective communication, conflict resolution skills, and consumer satisfaction within the staff.
• Performs monthly compliance audits as directed.
• Serves on various hospital committees as needed or assigned.
• Educates hospital staff and physicians on payer regulations and managed care principles 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.

Requirements

• Bachelor’s Degree in Nursing or Master’s Degree in Social Work.
• Must possess one of the following current licenses as required by the 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).
  • WV 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.
  • PA Licensed Clinical Social Worker (LCSW) through the Pennsylvania Board of Social Workers, Marriage and Family Therapists, and Professional Counselors.
  • Licensed Social Worker (LSW) through the Pennsylvania Board of Social Workers, Marriage and Family Therapists, and Professional Counselors.
• Five (5) years of Nursing or Medical Social Work experience (two (2) of which are in an inpatient hospital setting).
• Two (2) years of Care Management or supervisory experience.

Preferred Qualifications

• Care Management Certification.

Skills

• 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; flexible, open-minded, and adaptable to change.
• Expert team-building skills, problem-solving abilities, and conflict resolution strategies.

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Prolonged walking, standing, or sitting may be required.

Working Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Flexible hours to include weekends and holidays.

Scheduled Weekly Hours: 40