Manager - case management

Description Job Shift: Days Job Type: Full Time

The individual in this position has overall responsibility for coordinating the daily activities of the case management team, while overseeing the clinical plan of care to conform with evidence-based practice and/or regulatory/payor requirements. This position integrates functions typically considered to be case management, care coordination and/or utilization management, and discharge planning assessment and coordination.

Responsibilities

The individual’s responsibilities will include, but not be limited to, the following activities:

• Coordination of clinical care (medical necessity, appropriateness of care, and resource utilization for admission, continued stay, discharge, and post-acute care) compared to evidenced-based practice, internal and external requirements.
• Identify and report variances in appropriateness of medical care provided over/under utilization of resources compared to evidenced-based practice and external requirements. This priority includes work with relevant software and communicating information through clear, complete, and concise documentation in CM software.
• Effective collaboration with physicians, nurses, ancillary staff, payors, patients, and families to achieve optimum clinical outcomes.
• Remain current with relevant clinical/case management practices.
• Assist Director with daily operational oversight and supervision of departmental staff.

Qualifications

Education: Required: Graduate of an accredited school of nursing Preferred: Academic degree in nursing (bachelor's or master's)

Experience: Required: 2 years of acute hospital case management or healthcare experience. Preferred: 5 years of acute hospital case management leadership experience

Certifications: Required: RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered. Preferred: Accredited Case Manager (ACM) #LI-LG2