Manager, Care Management (Full-time/On-site)

Job Details

Description

Position Summary:

The Manager Care Management leads, plans and supervises activities of utilization review/case management function involved in following patients throughout the continuum of care to ensure optimum utilization of resources, service delivery and compliance with external requirements.

Essential Duties And Responsibilities

• Leads interdisciplinary efforts to ensure patients receive the right care at the right time. This includes ensuring InterQual criteria is determined to maximize proper bed utilization to enhance access to care and maximize revenue streams as appropriate.
• Directs, plans and supervises activities of case managers and social workers in following patients throughout the continuum of care. This includes strategic planning and daily management of operations related to case management for all inpatient units; ensure optimum utilization of resources, service delivery and compliance with external requirements.
• Leads integrated efforts to implement effective care transition strategies that reduce length of stays, reduce readmission rates.
• Plans, schedules and organizes work for staff ensuring proper distribution of assignments and efficient utilization of personnel, space and facilities; direct the requisition, care and maintenance of department inventory.
• Participates in multidisciplinary team meetings regarding the planning and implementation of patient care; facilitate communication and problem solving related to discharge planning.
• Maintains required records, reports and statistics for administrative purposes; ensures compliance with established hospital policies, procedures, objectives, performance improvement, safety, environmental and infection control practice.
• Maintains liaison with physicians, hospital administration and ancillary department managers to analyze unit needs, identifies problems and effects change as needed to improve services.
• Determines fiscal requirements of department and prepare budget
• Directs various personnel actions including, but not limited to, hiring, performance evaluations, disciplinary actions and scheduled time off.
• Investigates over and underutilization cases, implements corrective action and reviews all denial letters for reconsideration appeal.
• Implements and supports HPH’s strategic priorities and quality initiatives while ensuring regulatory compliance.
• Participates in the Utilization Management Committee and provide monthly statistical activity report.
• Investigates over and underutilization cases, implements corrective action and reviews all denial letters for reconsideration appeal.
• Implements and supports quality initiatives in the department. Ensures regulatory compliance.
  
  

Qualifications

• Minimum 3-5 years of experience
• Bachelor’s degree, Master’s degree preferred
• Must have current IL RN License or LCSW licensure