Description

Job Purpose

The Case Management Manager is responsible for the day-to-day management of the Case Management department. This includes, but is not limited to supervision of staff, staff assignment/productivity, staff recruitment, retention, daily staffing, employee performance evaluation, performance improvement, and staff education. 

 
The Case Management Manager serves as a resource/mentor for Case Managers, Social Workers and other medical and hospital staff, and participates in the development and implementation of new initiatives that support excellence in patient experience and drive efficiency and efficacy of the case management operations.  The Case Management Manager reports to and assists the Directors of Case Management and Social Work. 
 

Duties and Responsibilities

Clinical Leadership:
Develops, implements, and maintains professional standards
 
Serves as a clinical resource and lends guidance to staff in utilization management, discharge planning, and care coordination issues
 
Provides operational and clinical oversite to ensure that all day-to-day activity supports optimum patient throughput and excellent patient care
 
Demonstrates integral involvement in the quality improvement activities of the case management department
 
Works with the case managers, clinical nurse managers, physicians, and social work to facilitate Interdisciplinary Rounds to ensure compliance with the patient treatment plan
Facilitates patient flow and monitors length of stay for each patient
 
Collaborates with the Directors of Case Management and Social Work to maintain, review and update all policies in accordance with hospital, professional and regulatory standards
 
Creates and maintains an environment of care where patients, families, staff and others are treated with respect, dignity and in a professional manner, promoting an environment respectful of cultural diversity
 
Attends interdisciplinary rounds as necessary
 
Meets with Case Managers and Social Workers to review medically complex and long stay cases and refers to physician advisors as required
 
Regularly reviews avoidable day, excess day and denial data for follow-up and development of process improvement actions as necessary
Ensures UM deliverables are met such as timely admissions and continued stay reviews
Other duties as assigned
 
 
Administration
 
Coordinates activities to maintain patient throughput and facilitate the flow of information from other   

departments to staff
 
Manages staffing, daily assignments and productivity
 
Coordinates staff meetings
 
Encourages and facilitates professional growth and development of staff
 
Promotes a positive environment that encourages staff to participate in the identification of areas of opportunity for improvement in length of stay, throughput and appropriate level of care
Management of Human Resources and Staff Development
Ensures that personnel issues are managed in compliance with contractual agreements and supports positive employee-management relationships
 
Evaluates staff performance and productivity on an ongoing basis and completes staff performance appraisals in a timely manner. Provides recognition of exemplary employee performance and also provides employee counseling / progressive discipline as necessary
 
Ensures all personnel are appropriately licensed, credentialed, competent and complete ongoing/annual educational programs as required
 
 
 
 
      Communicates information thoroughly and composes and distributes daily, weekly, and monthly reporting as needed.

      Communicates appropriate and accurate information to the supervisor/director of the Case Management department.

      Inputs data into the computer systems accurately relevant to all Case Management activities, Utilization Review and other items managed by the Case Management department.

      Maintains electronic and manual files of all Case Management activities, process improvement initiatives and results

      Forwards information to other departments as indicated

      Utilizes various systems to track and report on departmental activity

      Coordinates and provides reports as requested

      Manages and reviews patient cases for accuracy and completeness without compromising quality in entering area specific information

      Adheres to required timeframes and deadlines for reporting and work requirements

      Effectively identifies and communicates barriers preventing accurate data entry and report generation to leadership

      Manages the Case Management tracking system(s) and reporting functions

      Requests medical records for retrospective reviews from the Health Information Management department

      Performs other related duties as assigned

      Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

      Understand and comply with Information Security and HIPAA policies and procedures at all times

      Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Requirements

Qualifications

Education: BSN, Master’s Degree in Nursing or health related field, including LCSW 
Experience with Case Management software desired (CarePort/Wellsky/MCG/etc)
Ability to complete tasks with a high degree of accuracy
Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
Elevated level of integrity and dependability with a keen sense of urgency and results driven approach
Advanced level of Excel proficiency and experience in financial modeling and analysis
Advanced Microsoft PowerPoint and Word skills
Exceptional communication and interpersonal skills, with the ability to effectively interact with clients, colleagues, and stakeholders at all levels in a quickly responsive and articulate manner
Strong analytical and problem-solving abilities, with a data-driven approach to decision-making and a focus on continuous improvement
Ability to adapt to a fast-paced and changing environment, managing multiple priorities and deadlines effectively
Working Conditions

Occasional travel and flexibility to work outside of normal business hours as needed
Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear
Mental Demands: The employee must be able to follow directions, collaborate with others, and manage stress
Work Environment: The noise level in the work environment is usually minimal
 

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.