Care Coordination is a collaborative practice model including the multidisciplinary health care team, the patient and family, and community services and resources. The Care Coordination process encompasses analysis of information, use of evidence-based guidelines, communication among the care team and patient/family and facilitates care along the continuum through effective resource coordination. Overarching goals, in alignment with the Crouse Mission, Vision and Values, include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to self-determination.

The Manager of Care Coordination is responsible for providing day to day management of the RN Care Managers in the department. Areas of authority include Utilization Management, Discharge Planning and Denials and Appeals functions. General operational oversight including hiring training and evaluating staff. Representing the department on assigned committees and work groups. Developing and implementing workflows, policies, procedures and auditing performance. The manager is the point person for problem escalation and troubleshooting for the staff. The Manager stays abreast of the regulatory environment specific to areas of responsibility and develops and implements strategies for compliance.

Job Requirements:

minimum education/certification/ licensure:

• Currently licensed as a Registered Professional Nurse in New York State
• Bachelor’s Degree

minimum experience:

• Required: A minimum of five (5) years previous case management, utilization review, appeals and denials and discharge planning experience preferably in an acute care setting.

• Preferred: Previous leadership experience in a healthcare setting preferred.

special skills/equipment: Working knowledge of MS Office. Expert knowledge of clinical review criteria such as Interqual, Milliman or other. Working knowledge of CMS regulations pertinent to UM, Discharge Planning, beneficiary rights and benefit coverage.