Rush Copley is seeking a Manager of Case Management and Care Transitions who is a leader with accountability for planning, organizing, staffing, coaching, facilitating, and motivating staff members of the Care Management/Appeals team. This Manager is responsible for the department’s operations including the ED Care Management program, human resources, financial management, and process improvement initiatives. Works with clinical teams and medical staff to evaluate the appropriate utilization of facilities and ensure efficient and effective resource management. Acts in collaboration with other hospital departments to ensure compliance with regulatory requirements including accurate medical necessity documentation, inpatient claim denial review and appeal management. The Manager provides direction and vision for the department and exemplifies the Rush Copley mission, vision, and values and acts in accordance with policies and procedures. This position works closely with all multidisciplinary team members to assure the highest degree of evidenced-based practice is provided, keeping the care and safety of all patients as a top priority. 

Must be licensed and currently registered to practice as a Registered Nurse
 
Education: Earned nursing degree at the baccalaureate level or higher required. Graduate degree preferred. Expected completion within 5 years of hire
 
Certifications: Specialty certification preferred.

Special Skills: Strong project management and innovation skills. Possesses an in-depth understanding of quality improvement and rapid cycle improvement methodologies. The ability to interact with all members of the interdisciplinary team and to build credible collaborative relationships. Knowledgeable of comparative databases, risk adjustment, statistical process control methods, and decision support tools. Able to work independently with effective follow-through and accountability. 
Experience: Experience in Care Management, Utilization Management and Appeals required.