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Manager, Case Management F/T Days

Company: Hackensack University Medical Center
Location: Hackensack
Posted on: June 6, 2021

Job Description:

Overview

The Manager of Case Management, is responsible for all activities related to Case Management including, but not limited to, Utilization Management, discharge planning, ensuring there is supporting medical necessity, and denial prevention. Ensure transition management promoting appropriate length of stay, readmission prevention and patient satisfaction. Provide Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care; and education provided to physicians, staff, patients, families and caregivers.

Responsibilities

  1. Serves as a key participant in the design, implementation and monitoring of the case management program. 2. Leads the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement. 3. Participates in the budgetary planning and execution for the Case Management department with emphasis on monitoring expenditures in supplies, equipment, staffing, and cost control measures. 4. Establishes a collaborative relationship with physicians, medical directors, nurses and other unit staff, and payers. Collaborates with physicians to understand medical practice issues. 5. Participates in the development of department policies and procedures and process improvements. 6. In the absence of the Administrator of Capacity Management, the Manager of Case Management, will assume responsibility for the Case Management initiatives. 7. Seeks assistance of physician advisors, appropriate Chair and/or Vice Chair to assure compliance with correct patient status, timely discharges/transfers in accordance with length of stay criteria. 8. Trends data and identifies opportunities to improve current practice. 9. Manages department operations to assure effective throughput and reimbursement for services provided. 10. Directs day to day operations ensuring compliance with regulatory requirements. Monitors and implements legal compliance measures. 11. Ensure medical necessity review processes are completed accurately and in compliance with CMS regulations. 12. Ensure timely and effective patient transition and planning to support efficient patient throughput. 13. Develops and implements an integrated process for the functions of Care Coordination, Utilization Review and Discharge Planning which includes working collaboratively with other disciplines. 14. Implements and monitors processes to prevent payer disputes. 15. Tracks and trends data to identify areas for denial prevention. 16. Develop and provide physician education and feedback on hospital utilization. 17. Ensure compliance with state and federal regulations and Joint Commission accreditation standards. 18. Refers cases identified as risk management issuers, peer review issues, or quality issues to the appropriate personnel. 19. Develops and establishes effective systems that ensures the required functions are performed; Medical Necessity reviews; including reviews of the appropriateness of admissions (observation versus inpatient admission status) and length of stays. 20. Monitors patient and family satisfaction through system approved measures, participate in the development and monitoring of any departmental quality initiatives. 21. Works with department supervisors to determine and monitor workload productivity standards for staff. 22. Identifies trends and performance improvements. Coordinates training based on identified need. 23. Has the authority to evaluate, hire, counsel (using established disciplinary process) and terminates staff in accordance with Human Resource policies. 24. Evaluates performance of staff and completes performance appraisals. 25. Maintains knowledge of regulatory and professional standards and communicates these standards as needed. 26. Adheres to the standards identified in the medical center's organizational and managerial competencies. 27. Ensures that CM staff provides clinical information to the appropriate payer source as required or requested through approved HIPAA and confidential methods in a timely manner to facilitate financial coverage of the hospitalization and to avoid denials of coverage. 28. Exhibits clear communication skills with all internal and external customers. Provides excellent service routinely in interactions with all customers, coworkers, patients, visitors, physicians, volunteers, etc.

Qualifications

Education, Knowledge, Skills and Abilities Required: 1. Bachelor's degree in nursing. 2. Master's degree in nursing or related field 3. At least 5 years full time experience in an acute care setting. 4. Familiar with hospital resources, community resources, and/or resource/utilization management. 5. Care coordination, case management, discharge planning and/or utilization review experience. 6. Effective decision-making /problem-solving skills, demonstration of creativity in problem-solving, and influential leadership skill. 7. Excellent verbal, written and presentation skills. 8. Moderate to expert computer skills Education, Knowledge, Skills and Abilities Preferred: 1. Minimum of 2 years of experience in Nursing Leadership. 2. 3-5 years previous experience in Case Management. 3. Extensive knowledge of MCG guidelines and EPIC. 4. Working knowledge of the financial aspects of third party payers and reimbursement. Licenses and Certifications Required: 1. NJ State Professional Registered Nurse License. 2. Accredited Case Manager Certification or Certified Case Manager. Licenses and Certifications Preferred:

Keywords: Hackensack University Medical Center, Hackensack , Manager, Case Management F/T Days, Other , Hackensack, New Jersey

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