Manager, Case Management
Location: Leominster Massachusetts
Description: HealthAlliance Hospital is currently interviewing Manager, Case Management right now, this occupation will be placed in Massachusetts. For complete informations about this occupation opportunity please give attention to these descriptions. GENERAL SUMMARY:
Provides operational supervision of the case managers, clinical social workers and associate staff. Focuses on utilizatio! n review, payer audit activity and ongoing performance improvement initiatives.
PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:
Monitors utilization review activities for the hospital, interfacing with external payers and review companies to determine appropriate medical necessity of admissions and continued hospitalization
Provide staff education regarding review criteria
Establishes effective communication systems and forums with third party payers and the local PRO/QIO
Evaluates staff’s application of utilization review criteria
Maintains denial management program
Identifies proactive opportunities to enhance utilization review outcomes
Establishes effective relationships with individual physicians, physician groups and Interdisciplinary team members to enhance care planning, care delivery and discharge planning.
Develops and maintains effective relationships with hospital department heads, nursing managers, administrators and ! administrative staff
Communication clinical documentation ! improvement opportunities with multidisciplinary care providers
Ensures compliance with federal, state, regulatory agencies and collaborates with Compliance on new policies and/or procedures.
Direct management and supervision of the nurse case managers, clinical social workers, administrative assistant and case management resource assistant.
Complete performance evaluations, orientation, scheduling and training
Make recommendations on employee hires, transfers, promotions, salary changes, discipline, terminations and similar actions.
Resolve grievances and other personnel problems within position responsibilities
Provides effective direction, guidance and leadership over the staff for effective teamwork and motivation.
Takes responsibility for ensuring that all work outcomes satisfy the HealthAlliance Three Pillars: Finance, Quality, and Service Excellence.
The individual must support the mission, vision, and goals of HealthAlliance Hospitals! and serve as a role model for the CARES- It Happens Here customer service initiative.
Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.
Demonstrates a friendly, responsive, service-minded attitude to all internal and external customers.
Communicates ideas effectively. Shares information and keeps others properly informed. Gives, and is open to useful feedback.
Adheres to the HealthAlliance Hospital Code of Conduct and Behavior Standards and dress code.
Complies with established environment of care/safety policies and procedures and all health and safety requirements.
Maintains, and fosters, an organized, clean, safe work environment.
Actively contributes to the development and application of process improvements.
Maintains a collaborative, team relationship with peers and colleagues in order to effectively contribute to the group’s achievement of goals and to help foster! a positive work environment.
Demonstrates respect for the diversit! y of patient and employee populations. Supports and encourages diverse points of view, work and lifestyles.
Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.
Performs a variety of related duties as assigned.
JOB REQUIREMENTS
JOB KNOWLEDGE AND SKILLS:
The Manager, Case Management must demonstrate the ability to:
Establish goals, vision and overall direction of a department
Understand payer requirements and discharge planning regulations
Create and implement department standards, systems, a staffing plan and processes
Analyze issues and create an effective plan to address them
Critically and comprehensively evaluate the department’s outcomes
Identify, collect and analyze data related to the internal and external environment
Communicate clearly and effectively verbally and in writing
Establish priorities, meet deadlines and develop and manage! the department’s productivity standard in the management of the work assignment
Form positive, collaborative relationships with members of the executive team, hospital staff, post acute providers and payers.
Problem solve in a proactive, creative manner, using sound judgment based on factual information and clinical knowledge.
Negotiate with external and internal service providers
Understand the external requirements that impact the department (JCAHO, DPH, etc)
EDUCATION:
Master’s degree in Nursing or Healthcare administration preferred, or actively working towards the same
EXPERIENCE :
Minimum of 3-5 years of experience in case management, discharge planning, and/or utilization review experience preferred.
Prior experience in management or administrative position preferred
An equivalent combination of education and experience which provides proficiency in the areas of responsibility listed above may be su! bstituted for the above education and experience requirements.
! LICENSES, CERTIFICATIONS, ETC. :
Registered Nurse (RN) in the state of Massachusetts
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This occupation starts available on: Tue, 12 Mar 2013 21:22:36 GMT