Manager of Care Management

Benefits

• Competitive salary with a comprehensive benefits package, including:
  • 401(k) match
  • Paid Time Off (PTO)
  • Medical, dental, vision and flexible spending accounts
  • Life and disability insurance and more

Job Summary

The Manager, Care Management is responsible for the planning, coordination, and oversight of care management services, including utilization review, discharge planning, and transitions of care. The role ensures care is appropriate, timely, cost-effective, and aligned with patient needs and organizational goals. The Manager leads the daily operations of the Care Management department, supervises staff, and collaborates with physicians, nurses, payors, and other healthcare team members to facilitate care coordination, improve outcomes, and support effective resource utilization.

Essential Functions

• Manages the daily operations of the Care Management department, ensuring services are delivered efficiently, effectively, and in compliance with organizational standards.
• Oversees utilization review and discharge planning processes to ensure appropriateness of admission, continued stay, diagnostic services, and discharge readiness.
• Directs and prioritizes workload based on patient length of stay, diagnosis-related groups (DRGs), charges, reimbursement, and other risk factors.
• Evaluates patients through chart review, interviews with providers and staff, and patient assessments to support care planning and transitions.
• Collaborates with physicians, nurses, ancillary services, and payors to streamline care, resolve barriers, and ensure timely discharge planning.
• Monitors observation stays and ensures compliance with regulatory requirements, timely admission, or discharge decisions.
• Prepares and delivers reports on utilization, care management performance, and variance from expected outcomes to facility and organizational leadership.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Leadership Responsibilities

• Supervision and Staff Management
  • Provides leadership, mentorship and professional development opportunities for departmental staff.
  • Schedules employees to ensure effective use of resources. Consults with Director on staffing issues.
  • Conducts performance evaluations, sets goals and provides feedback to staff on their performance and development.
• Strategic Planning and Financial Oversight
  • Develops and manages departmental budget ensuring cost effective operations while maintaining high quality service.
  • Monitors expenditures, ensuring cost-effective delivery of services.
  • Evaluates and implements new technologies to enhance operational efficiency.
  • Develops and implements departmental policies and procedures and protocols to optimize quality and overall efficiencies.
• Quality Assurance and Regulatory Compliance
  • Ensures compliance with all relevant regulatory bodies. May oversee the accreditation process with relevant agencies ensuring that services meet or exceed industry standards.
  • Participates in audits, inspections and accreditation processes as applicable.
  • Follows established quality control practices to ensure accuracy, consistency and safety.
• Collaboration and Communication
  • Works closely with leadership teams to coordinate and improve service delivery.
  • Stays up-to-date with industry advancements, new technologies, and regulatory changes.
• Staff Responsibilities
  • May work in a staff role, when required. Ensures that duties and responsibilities are fulfilled while meeting all competencies established for that job.

Qualifications

• Bachelor's Degree in relevant field required or
• Four (4) plus years of direct experience in lieu of a Bachelor's degree required
• Master's Degree preferred
• 2-4 years of experience in closely related field with Bachelor's degree required
• 2-4 years of previous leadership experience preferred

Knowledge, Skills and Abilities

• Strong leadership, organizational, and communication skills.
• Ability to collaborate with interdisciplinary teams and manage cross-functional relationships.
• Foster a positive work environment that promotes teamwork, professionalism, and continuous improvement.
• Communicate effectively with leadership, team members, and stakeholders.
• Ability to work effectively with others, delegate responsibilities, and independently manage tasks while meeting established deadlines.
• Problem-solving and critical thinking skills.
• In depth knowledge of industry best practices and regulatory compliance (if applicable).
• Strong organizational and time management skills.
• Proficiency with Google and Microsoft platforms, healthcare software systems, and data analysis tools.

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required or
• LCSW- License Clinical Social Worker required or
• LMSW - Licensed Medical Social Worker - State Licensure required

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