Case Management Nurse Manager
*** MUST BE A REGISTERED NURSE TO QUALIFY FOR THIS POSITION ***
Provides leadership and oversight of the Care Management (Case Managers and Social Work) program and staff assigned. Provides direct management and development of site Case Managers and Social Work staff. Collaborates frequently with Hospital Leaders, Post-Acute Partners, Physicians, Physician Advisors, Nurses, and others to ensure accurate and timely progression of care, discharge planning, and compliance with regulatory standards/conditions of participation related to discharge planning and utilization management. Supports ongoing communication and education on care coordination, discharge planning, alternate payment methods, regulatory requirements and performance improvement methodologies.
- Provides management oversight of the daily operations of the care management and social work programs at the assigned site(s). Approves and monitors staff schedules, paid time off, and time cards to ensure continuity of services. Monitors proficiency of each site CM/SW staff and includes action plans to improve deficiencies, meet regulatory requirements, and drive efficiencies. Responsible for team building and conflict resolution.
- Facilitates performance improvement activities for the care management program; assists to establish measures, performance targets, and benchmarks to drive achievement of established goals and achieve efficiencies of processes. Collects, analyzes, and reports data to measure and identify the effectiveness of care processes and variations from standards and expectations. Analyzes data and information to discern root causes of performance gaps using key data and reports.
- Identifies and discusses overall and individual physician trends related to care management activities with Director of Inpatient Care Management Operations, Physician Advisor and site Medical Staff Leadership as appropriate with a documented improvement plan to include strategies and educational needs identified. Regularly reviews individual site successes and improvement opportunities with the Director of Inpatient Care Management Operations, site leadership and other key stakeholders.
- Serves as an internal consultant on Care Management opportunities. Acts as an expert resource for care management program, including evaluation of challenging cases, intervening with physicians when necessary, meeting with patients and families, dissemination and interpretation of key regulatory requirements and changes, etc. Consults, communicates, and organizes key ongoing education, serves as a supportive member of site UM Committees, and/or other site meetings as appropriate. Participates in multidisciplinary cross functional efforts to ensure high quality, cost effective coordinated care. Works collaboratively with Physician Advisor(s) on challenging cases, removing barriers to discharge.
- Accountable for site care management/social work budgets as assigned. Develops and recommends operational and capital budgets and controls expenditure within approved budget objectives.
- Ensures the care management/social work program operates within compliance of CMS, OSHA, Accrediting Organizations, and established care management practice standards and code of ethics. Collaborates with Compliance to ensure care management/social work program meets all state and federal guidelines.
- Responsible for orientation, and ongoing competency assessment of CM/SW staff in collaboration with the Director of Inpatient Care Management Operations.
- Responsible for personal professional growth. Participates in professional organizations, maintains license and certification as required, maintains effective working relations with both internal and external customers. Maintains required competencies and assumes responsibility of personal development and maintenance of ongoing workshops, conferences, and/or in-services and maintaining records of participation.
M-F 08-1630 some flexibility maybe needed to meet with staff and department needs.
Licenses & Certifications
Registered Nurse license issued by the state in which the team member practices, and Accredited Case Manager (ACM) certification issued by the American Case Management Association (ACMA) needs to be obtained within 1 year, or Care Manager Certified (CMC) certification issued by the National Academy of Certified Care Managers (NACCM) needs to be obtained within 1 year, or Nursing Case Management (RN-BC) certification issued by the American Nurses Credentialing Center (ANCC) needs to be obtained within 1 year.
Bachelor's Degree in Nursing.
Required Functional Experience
Typically requires 5 years of experience in a relevant clinical setting.
Required Management Experience
1 year of supervisory experience in a Care Management Leadership role
Knowledge, Skills & Abilities
Master of Nursing Administration, Master in Health Care Administration or related field preferred. Ability to prioritize and organize work. Ability to travel and work across multiple sites as assigned (IL or WI). Effective communication skills. Utilization of critical thinking in timely decision making. Knowledge of MS Office products. Demonstrates leadership skills. Knowledge of Medicare A and B guidelines. Knowledge of Managed Care programs/requirements/implications. Knowledge of Conditions of Participation for Discharge Planning. Knowledge of requirement elements of Utilization Management program, including support of the UM Plan. Knowledge of Regulatory environment. Ability to work autonomously and respond to multiple requests effectively.
Our Hospital Healthcare System is committed to diversity and inclusion every single day and in everything we do. Diversity lives in the differences, great and small, that matter to us and make each of us unique - from our age and the color of our skin, to our abilities and the things we believe in. We know that empowering our differences inspires creativity that leads to innovative solutions - for our team members, consumers and communities. And because health care is built upon relationships, it's important for the people we serve to be able to trust us to meet their unique needs. By cultivating an atmosphere of acceptance and compassion, we create a welcoming environment where our patients can heal, our team members can thrive and our business can grow. As a team member, working in a diverse setting allows you the chance to grow in ways that will broaden your perspective to deliver the best possible patient care.
Qualified Candidates please forward your resume for review to Eric Clay at firstname.lastname@example.org or call Eric at 773-494-9365 for more information.
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