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Posted: 28-Feb-25
Location: Tyler, Texas
Categories:
Internal Number: 254391
Summary:
The Manager Care Management oversees the daily management of the Care Management Department. The Job is responsible for providing expertise and leadership to the Care Management team to insure the effective utilization of resources for patient care delivery and administrative staff. This Job will also enhance the continuity of care and cost effectively by integrating the functions of case management, utilization management and discharge planning.
Responsibilities:
- Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- Performs and/or is able to perform all the functional responsibilities of the Care Management team.
- Supervises the human resource functions for the selection, orientation, continued follow-up, support and performance appraisals of staff to ensure that all related actions are managed in accordance with established hospital and departmental policies.
- Monitors outcomes of associates on monthly basis by report card and meetings.
- Assist in the development and implementation of a systematic approach to monitor the effectiveness of the Care Management Program including resolution strategies.
- Maintain current policies and procedure. Provides education on P&P to associates.
- Coordinates the delivery of patient care within Care Management purview and ensures compliance with established hospital and regulating standards. Facilitates discharge planning processed in conjunction with other disciplines.
- Monitor Payer Initiatives: Provides information to the medical and hospital staff regarding current reimbursement, review regulations and guidelines, and processing of denials.
- Maintains a working relationship with community agencies and external reviewing and paying agencies including the professional review organization (PRO), Medicaid, CMS, private review organizations and third party payers.
- Monitor compliance of Avoidable Days of the CM associates and prepare report. Issue any letters needed to be given to physicians, departments, etc.
- Monitor compliance of Readmits of the CM associates and prepare report. Notify Quality Management of any issues dealing with readmits.
- Monitor schedules, PTO, and Time and Attendance policy to Associates in the Care Management Department.
- Ensures appropriate and comprehensive coverage of all hospital areas by maintaining department schedule and assignments.
- Adheres to formal Performance Review requirements for staff and provides real time coaching and mentoring for associates to enhance and improve case management performance.
- Monitor Care Management Associate education requirements and compliance for the Hospital?s annual requirement.
- Management of Denial Process; collaborate with Care Management Team to decrease the number of denials. Provide education and mentoring to team on denial issues. Will report to the denial meeting and perform any duties that may overturn denials. Bring knowledge to the denial meeting base on clinical experience.
- Guest Relations/Communications; Demonstrates positive role modeling of customer relations (customer include patient, physicians, other health care team members, and payers, etc.) Use AIDET and KWKT appropriately.
- Translates strategies into action steps; clearly assigns responsibility for decisions and tasks; sets clear objectives; monitors progress and achieves results.
- Demonstrates the confidence, drive and ability to face and overcome challenges and obstacles to achieve organizational goals.
- Appropriately adapts assigned assessment, treatment, and/or service methods to accommodate the unique physical, psychosocial, cultural, age-specific and other developmental needs of each patient served.
- Actively participates in Multidisciplinary/Patient Care Progression Rounds.
- Escalates cases as appropriate and per policy to Physician Advisors and/or CM Director.
- Documents in the medical record per regulatory and department guidelines.
- May be asked to assist with special projects.
- May serve a preceptor or orienter to new associates.
- Assumes responsibility for professional growth and development.
- Ability to move around the hospital to all areas for the majority of the workday while in office the rest of the day; general office and hospital environment.
- Performs other duties as assigned.
Job Requirements:
Education/Skills
- Associate Degree in Nursing or Master?s Degree in Social Work required.
Bachelor?s Degree in Nursing preferred.
Experience
5 or more years of experience in Case Management, Social Work, or Utilization Review required.
Licenses, Registrations, or Certifications
- RN, LCSW, or LMSW required in the state of employment.
- Certification in Case Management preferred.
Work Schedule:
5 Days - 8 Hours
Work Type:
Full Time
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