The Manager is responsible for overseeing daily operations of the department, serving as a role model, content expert and mentor for staff, preparing and adjusting the daily assignment of staff, monitoring patient flow adjusting assignment accordingly.
In addition, the Manager actively participates in assuring delivery of patient centered care serving as a content expert and supporting individual team members in working through complex care issues. This includes being first contact for all patient/family generated concerns with involvement of the Director of Population Health and Care Continuum as needed.
The Manager participates with the in developing and monitoring performance adherence to case management standards. This includes evaluation of outcomes and development of improvement initiatives.
The Manager provides support to the Utilization RN and collaborates with UR and Physician Advisors to assure appropriate use of hospital resources and identification of appropriate level of care to maximize revenue and quality.
The role requires autonomy, strong critical thinking, creative problem-solving, prudent clinical judgment. Clarity in operating within the scope of licensure and according to discipline specific case management standards of practice is essential.This individual seeks out educational and self-development opportunities related to care coordination, transitions of care, healthcare reimbursement, and other pertinent areas.
Key Content Areas-
Develops and promotes a departmental culture of excellence assuring that all team members are worth of respect.
Commits to maintaining an open dialogue, promoting a culture of safety, assuring that quality of care are department priorities.
Promotes the value of Case Management and Care Coordination within NWH.
Understands NWH organizational goals and priorities including patient/employee experience, quality and fiscal responsibility.
Serve as a positive professional role model, resource and team leader including effective communication to all health team members. Provides support and mentoring to staff.
Quality Assurance/Quality Management
Collaborates with the Director and other departments and disciplines to develop and maintain ongoing quality improvement and patient safety activities.
Follows up on safety reports and makes changes as needed.
Encourages and facilitates staff participation in quality improvement activities.
Monitors and evaluates the documentation of nursing practice and patient care.
Supports staff in handling customer service issues. The Manager will serve as first responder to patient/family/safety concerns. He/she may coach and support staff in managing concerns directly, she/he may intervene.
Maintains and implements departmental policies and procedures in accordance with Joint Commission, DPH, and other regulatory agencies.
Demonstrates content expertise and adheres to NWH standards and policies.
Establishes work schedules and assigns staff including RN Case Managers, Case Management Assistants, and Social Workers to units and areas of responsibility ensuring prompt, safe and clinically appropriate patient care. This includes coordinating coverage to support unit-based patient flow activities: admissions, discharges and transfers.
Assists individual CMs in handling changes in patient status and monitors for extended observation cases
Assumes accountability to delivering Hospital Issued Letters of Non-Coverage.
Facilitates effective rounding with the health care team, case manager, M.D. , pharmacy, clinical staff in an to promote patient care planning and flow.
Provides verbal and/or written reports to the Director on key patient information, upcoming patient flow activity, customer service concerns and unresolved issues requiring follow-up
Supervisory and Fiscal Responsibilities
Responsible for overseeing day to day operations of the Care Coordination Department.
With the support of the Director recruits, retains and develops competent staff.
Takes a lead role in recruitment of new staff.
Oversees preceptorship and orientation plans for new hires with support from discipline specific content experts.
Prepares performance appraisals in a timely manner and meets with employees to discuss performance expectations prior to the evaluation due date.
Takes corrective and/or disciplinary action when appropriate
Prepares time schedules according to hospital policies and validates hours worked.
Authorizes use of overtime and approves time off requests based on the needs of the department and hospital.
Demonstrates fiscal competence- in conjunction with the Director monitors, and effectively manages the operating and capital budgets.
Reviews departmental productivity reports and develops variance summaries
Manages the departmental payroll process
Bachelor's with Nursing major required
Master's degree in Nursing, Business Administration, or a related field preferred
Evidence of continued education and professional development.
CCM or ACMA certification preferred
Three to five years of prior relevant experience in case management/utilization management. This includes direct experience in
acute care hospital setting
healthcare reimbursement including utilization review
enhanced models of health care delivery
Previous supervisory experience preferred
Skills and Abilities
Required- demonstrated case management and utilization review expertise.
Ability to deal effectively with situational fluidity related to staffing, patient care concerns and organizational changes.
Autonomy in decision making drawing on objective assessment and using clinical judgment based upon information, clinical experience, clinical care processes.
Requires ability to seek out and identify resources to problem solve issues.
Commitment to work in and promote a multidisciplinary team.
Relevant technology and computer skills including knowledge of EPIC, Microsoft products and efficient data entry ability.
Excellent interpersonal communication skills, (written and verbal)