Case Management ManagerPosted: May 5, 2016
Responsible and accountable for clinical and financial operations of the Care Management system. The Manager provides hospital-wide leadership through effective managerial and educational direction in the areas of Care Management operations, resource management, patient flow through the continuum, DRG financial analysis, change management, managed care, guidelines/protocols, clinical documentation and systems improvement. Independent action is required to ensure an integrated process which will coordinate health care delivery across service lines. Frequent interfaces with Senior Leadership, Medical Staff, Quality, Ancillary Services and Nursing in a communicative and change management capacity. Promotes high quality patient care and cost effectiveness by proactively coordinating the entire spectrum of a patient's care; facilitating positive outcomes with appropriate use of resources.
Schedule: Full - Time- 40 hours
Contact: Gayle Martinez
• Graduate of an accredited school of nursing or BSN preferred.
Nursing, Social Worker or other related degree required.
. Certification in Care Management preferred.
• Current BCLS required.
• Requires a minimum of five (5) years recent acute care nursing experience.
• Three (3) years demonstrated nursing management in fast pace, complex environment.
• Multidisciplinary approach to clinical improvement.
• Fiscal Management.
• Managed Care concepts and strategies; DRG reimbursement.
• Convert DRG and Physician practice pattern data information into quantifying data which impacts costs and quality.
• Ability to implement new programs and problem solving mechanisms.
• Strong interpersonal communication skills.
• Experience in developing and presenting education programs.
• Competent computer skills to include Microsoft Office programs
• Excellent knowledge of Medicare/Medicaid/Third Party admission and concurrent review criteria.
• Knowledge of "Benchmark" and "Best Practice" methodologies.
• Ability to implement and initiate workload changes and set priorities.
• Care Management Practice/Guidelines, to include analyzing, trending and reporting variances
• Working knowledge of Milliman.
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