Registered Nurse (RN)- Manager of Case Management
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POST DATE 8/27/2016
END DATE 11/15/2016
JOB DESCRIPTIONJob Code: 00009-69981
Brief Summary of Position:
The Manager of Case Management is responsible for overseeing day-to-day operations within the Case Management department. Responsible for establishing appropriate staffing levels and work assignments, developing performance criteria for staff, serving as an expert resource on laws, policies and operational procedures, and ensuring that the operations of the Case Management department are consistent with facility organizational standards.
Duties and Responsibilities:
Provides management direction to the Discharge Planners, Utilization Reviewers, and Care Coordinators in Case Management department.
Identifies appropriate staffing levels, assignments and deployments for the department. Monitor performance criteria for staff members.
Reviews operations of the Care Management department to ensure high level of quality is consistent with organization standards.
Reviews department performance in relation to established goals. Implements changes to effect continual improvement in services provided
Interprets laws, policies, operational procedures and objectives. Ensures compliance with regulatory and legal requirements.
Shares with Director responsibility for collecting, analyzing, evaluating and presenting clinical management and operations data to a wide range of audiences.
Assists the Director in development of a comprehensive safety/quality and performance improvement program inclusive of the analysis and trending of data related to initiatives undertaken.
Work closely with medical staff leadership, clinical department chairs and committee chairs to ensure appropriate medical staff involvement in institutional resource management efforts.
Participates on assigned medical staff, executive and corporate committees; promotes effective communication between departments and entities, acting as a liaison to facilitate information sharing, collaborative problem solving and adequate provision of support services; fosters and maintains collaborative relationships within the hospital and the Health System, and with external agencies related to quality and performance initiatives as well as day to day operations issues that may arise.
Directly responsible for personnel actions including, but not limited to, hiring, performance appraisals, promotions, vacation schedules, and maintaining payroll records and time reports.
Collaborate with administration, management and educational resources to develop mechanisms for staff development and to make appropriate changes as needed to keep department current with new regulations, policies and trends in the Case Management field.
In collaboration with the Director, participates in the preparation of department budget. Make budgetary recommendations and projections. Monitor, verify and reconcile expenditures of budgeted funds, compiling information reflecting expenditures, and develop cost-comparisons. Identify cost savings within the operation.
Maintain skills in case management/utilization management to allow for coverage of a caseload as needed and/or to cover staffing shortages in the department.
Required Qualifications at this Level
5 years of relevant experience required
Management experience preferred
Degrees, Licensure, and/or Certification:
Must have current RN licensure in the state of Texas
Knowledge, Skills, and Abilities:
Experience with care coordination, discharge planning, clinical documentation and Utilization review
PC proficiency and experience with care management workflow systems, such as Canopy
Knowledge of InterQual criteria and patient status change
Strong communication and leadership skills
Knowledgeable of JCAHO, federal and state standards/regulations Considerable knowledge of large-scale health care facilities, policies, and issues
Considerable knowledge of clinical protocols and practice management requirements in assigned area
Ability to analyze data and employ approved management techniques and statistical tools to obtain maximum effectiveness, efficiency, and information
Ability to interpret established policies into operating procedures and to execute case management programs
Ability to coordinate effectively various functions and activities for maximum cooperation and efficiency
Ability to direct, instruct and advise staff in the approved methods, procedures and practices employed in effective health care administration
Ability to receive and effectively react to day-to-day problems presented by staff as well as others
Knowledge of accreditation standards, health care regulations, performance improvement, patient safety and policy formulation
Effective organizational, oral and written communication skills, problem solving, program development, computer skills, strong leadership, and team building skills
Ability to work with a variety of disciplines and levels of staff across departments and the health system is required
Knowledge of payer requirements and discharge planning regulations that support the effect development of departmental policies, procedures and standards
Ability to establish priorities, meet deadlines, develop and manage the department's productivity standard in the management of the work assignment
Ability to form positive, collaborative relationships with members of the executive team, hospital staff, post-acute providers and payers Ability to effectively negotiate with internal and external service providers
Knowledge of information systems to support the evaluation of current capacity as well as future needs
Last Edited: 08/26/2016