Manager - Case Management - Springfield Market

Job description

Manager, Care Management

The Manager, Care Management is responsible for day-to-day oversight, coordinating, organizing and managing functions and resources for the Care Management Department. This role collaborates and coordinates with Care Management Leadership and colleagues to achieve standardization of assigned functions and responsibilities. This role combines the clinical and the financial components to achieve the best possible outcomes for the patients served and the organization.

Essential Job Functions

Provides leadership and oversees day-to-day operations to Care Management Team. Works with Care Management leadership and colleagues to achieve standardized practices and processes related to Advance Care Planning, Length of Stay (LOS) management, readmission prevention, use of predictive readmission tool and application of appropriate interventions, denial prevention related to medical necessity through proactive progression of care and addressing barriers to (including tracking of avoidable days or delays), daily team rounding, care transitions, patient satisfaction related to care transitions. Monitors success through qualitative and quantitative data and takes appropriate action to mitigate barrier and improve outcomes.

Advocates and educates regarding right care, right time at the right place. Provides education to care management staff, physicians and nursing, other care teams members regarding effective progression of care, Level of Care (LOC), and safe and timely transition management. Supports national standards for care management scope of service: Education, Care Coordination, Compliance, Transition Management and Resource Utilization.

Utilizes systems within the Care Management Department to support an effective and proactive care management process across the continuum, working closely with and aligns with population health and community health efforts supporting a patient-centered care management model that spans the continuum. Collaborates with ambulatory and post-acute providers and staff to ensure seamless transitions of care.

Partners with physician leader to optimize the Utilization Management Committee, providing actionable data related to utilization opportunities identified through qualitative data and quantitative data analytic platforms such as Quality Advisor and other facility or system resources.

Directs daily operations to achieve effective utilization of personnel resources consistent with patient and ministry needs. Assist in development of annual departmental goals and objectives, aligns with system Care Management goals and objectives. Assists in development of strategic departmental plans and initiatives. Fosters integration and strong collaborative partnerships with nursing, quality, hospitalist, physician advisor, other physician leadership in supporting and engaging in clinical integration activities in order to optimize high quality, cost efficient care.

Participates in the development and management of the annual budget. Identifies and achieves cost reductions. Works in concert with organization colleagues to achieve standardization of operations. Understands the financial impact of contracts and changing payment models from fee-for-service to value-based care. Works collaboratively with staff and other key stakeholders to reduce cost.

Models professional conduct with Care Management leadership, staff, and all customers. Takes initiative to educate self and staff on the changing healthcare landscape including fee-for-service to value-based models, care model innovations, research and leading evidenced based practices. Promotes and models service excellence behaviors and educates others in service excellence principles. Exhibits flexibility and enthusiasm in style and can adjust to constantly changing economic, technical and strategic shifts. Ensures compliance with federal, state, and local regulations and accreditation requirements impacting care management service.

Licensing/Certification

BLS Basic Life Support – American Heart Association (required)

RN License in state of practice or Licensed as a Social Worker in state of practice (required, SW license preferred in VA)

Accredited Case Manager Certification (ACM) from American Case Management Association or Certified Case Manager (CCM) from Commission for Case Manager Certification or American Nurses Credentialing Center (ANCC) Nursing Case Management board certification (preferred)

Education

Bachelor of Science Nursing or Social Work (required)

Masters, Nursing, Social Work, or Healthcare Administration (preferred for BSMH, required for RSFH)

Work Experience

3 years of recent acute hospital care management experience (required)

What we offer

Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)

Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts

Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders

Tuition assistance, professional development and continuing education support

Benefits may vary based on the market and employment status.

Worksite address

urbana, OH, 43078, US

Who can apply

Review the original listing for work authorization, qualifications and employer requirements.