Manager Case Management

Job Purpose

The Manager, Case Management is responsible for the day-to-day management of the Case Management department. This includes, but is not limited to supervision of staff, staff assignment/productivity, staff recruitment, retention, daily staffing, employee performance evaluation, performance improvement and education.

The Manager, Case Management serves as a resource/mentor for Case Managers, Social Workers and other medical and hospital staff, and participates in the development and implementation of new initiatives that support excellence in patient experience and drive efficiency and efficacy of the case management operations. The Manager, Case Management reports to and assists the Directors of Case Management and Social Work.

Duties & Responsibilities

• Develop, implement and maintain professional standards
• Serve as a clinical resource and lend guidance to staff in utilization management, discharge planning, and care coordination issues
• Provide operational and clinical oversite to ensure that all day-to-day activity supports optimum patient throughput and excellent patient care
• Demonstrate integral involvement in the quality improvement activities of the case management department
• Work with the case managers, clinical nurse managers, physicians, and social work to facilitate Interdisciplinary Rounds to ensure compliance with the patient treatment plan
• Facilitate patient flow and monitor length of stay for each patient; Meet with Case Managers and Social Workers to review medically complex and long stay cases and refer to physician advisors as required
• Collaborate with the Directors of Case Management and Social Work to maintain, review and update all policies in accordance with hospital, professional and regulatory standards
• Create and maintain an environment of care where patients, families, staff and others are treated with respect, dignity and in a professional manner, promoting an environment respectful of cultural diversity
• Attend interdisciplinary rounds as necessary
• Regularly review avoidable day, excess day and denial data for follow-up and development of process improvement actions as necessary
• Ensure UM deliverables are met such as timely admissions and continued stay reviews
• Coordinate activities to maintain patient throughput and facilitate the flow of information from other departments to staff
• Evaluate staff performance and productivity on an ongoing basis and complete staff performance appraisals in a timely manner. Provide recognition of exemplary employee performance and also provide employee counseling / progressive discipline as necessary.
• Coordinate staff meetings
• Encourage and facilitate professional growth and development of staff
• Promote a positive environment that encourages staff to participate in the identification of areas of opportunity for improvement in length of stay, throughput and appropriate level of care
• Ensure that personnel issues are managed in compliance with contractual agreements and supports positive employee-management relationships
• Ensure all personnel are appropriately licensed, credentialed, competent and complete ongoing/annual educational programs as required
• Communicate information thoroughly and compose and distribute daily, weekly, and monthly reporting as needed
• Input data into the computer systems accurately relevant to all Case Management activities, Utilization Review and other items managed by the Case Management department
• Maintain electronic and manual files of all Case Management activities, process improvement initiatives and results
• Forward information to other departments as indicated
• Utilize various systems to track and report on departmental activity
• Manage and review patient cases for accuracy and completeness without compromising quality in entering area specific information
• Adhere to required timeframes and deadlines for reporting and work requirements
• Effectively identify and communicate barriers preventing accurate data entry and report generation to leadership
• Manage the Case Management tracking system(s) and reporting functions
• Request medical records for retrospective reviews from the Health Information Management department
• Other duties as assigned
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• BSN, Master’s degree in nursing or health related field, including LCSW
• Experience with Case Management software desired (CarePort/Wellsky/MCG/etc.)
• Ability to adapt to a fast-paced and changing environment, managing multiple priorities and deadlines effectively
• Advanced proficiency in Microsoft Office Suite, including experience in Excel financial modeling and analysis
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction

Working Conditions

• Occasional travel will be required.
• Ability to work outside of normal business hours as needed.
• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.