Assistant Nurse Manager, Case Management

Tips: Provide a summary of the role, what success in the position looks like, and how this role fits into the organization overall.

The Assistant Nurse Manager of Case Management uses evidence-based skills to support the delivery of effective and efficient patient care.  Case Manager Nurses address patient needs from both a physiological and economic perspective while retaining overall accountability for both. The Assistant Nurse Manager of Case Management is a hands-on role which oversees both Utilization Management and Transitional Care Management for Patients currently receiving care at our Hospital. In this role the Assistant Nurse Manager will partner with members of the health care team including Social Workers to assess patients and implement an appropriate plan of care. Additionally, this role is responsible for the successful interpretation of nationally recognized criteria sets to support medical necessity for both admissions, and continued stay. Finally, along with the patient, family, and health care team, this role ensures that a safe and effective discharge plan has been created. 

Responsibilities

Directly manages the day to day operations in the case management department.

Provides direct management to the department staff, manages scheduling, and oversees the orientation of new hires. 

Evaluates and optimizes patient satisfaction with discharge planning functions. Attempts to resolve conflicts related to discharge planning with staff, patients/families, external agencies and payers.

Assist the physician advisors in writing appeal letters to Insurance Companies

Works with the Revenue Cycle team to minimize Insurance denials.

Works with Insurance companies and the Physician Advisor to establish and communicate inpatient care severity of illness and intensity of service.

Provides support and guidance over utilization management including assisting the Physicians/Surgeons, APRN’s, and PA’s with level of care determinations. 

Maintains department metrics and audits. Provide updates to their corresponding committee or administrator.

Qualifications

The preferred candidate:

Has 5-7 years of Case Management / Utilization Management with progressively responsible experience

Exposure to Social Work, Clinical Documentation and Utilization Review in addition to hands on Case Management experience.

Has implemented processes and work on process improvements with demonstrable results

Is metrics focused and a champion of process improvement

Is a strong coach and mentor with good listening skills

Is able to establish credibility and gain the respect of his/her team as well as senior management

Is a decision maker that can deliver a roadmap and hold his/her team accountable

Empowers his/her team to solve problems and come up with solutions

Partners with operations for creative problem solving and goal setting

Has strong organizational skills

Strong familiarity with acute care case management regulations.

Educational / Minimum Requirements:

BSN degree (or active work toward BSN) required. Master’s degree is preferred.

State/Federal Mandated

RN Licensure Required

Bristol Hospital Mandated Educational Requirements:

General orientation at time of hire. Fire/Safety/Infection control annually. Other programs as required by The Hospital, JCAHO, DPH, OSHA, and other credentialing organizations.

Work Environment:  

Office and Hospital setting. This is not a remote role.  

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.