Boise, Idaho, USA
17 days ago
Manager, Care Coordination and Utilization Management
Employment Type:Full timeShift:Day Shift

Description:Responsible for the day to day operations of Clinical Resource Management/Case Management, Social Work, Bundled Payment for Care Improvement and Transition Support at Nampa. Responsible for lead management for the development, communication and successful execution of established objectives (financial and non-financial) within the service line, operational, or staff support function as articulated through the organizational structure and the strategic and tactical plans. Inclusive of managing staff performance and productivity, utilizing change management process/tools, maintaining compliance with regulatory and safety requirements, maintaining current knowledge of payer/reimbursement requirements, and adhering to the Trinity Health Case Management Excellence standards.

SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:

Licensed in the State of Idaho as a Registered Nurse as defined by the Idaho State Board of Nursing. Bachelor’s Degree in Nursing or other appropriate health care related field required; Master's Degree in Nursing preferred. 5 years of nursing experience required, preferably in service specialty. Must have strong communication, assessment, and management skills.Intermediate to advanced computer skills required.Financial Data interpretation, Statistical Analysis, Project Planning skills preferred.

ESSENTIAL FUNCTIONS:

Knows, understands, incorporates, and demonstrates the Organization's Mission, Vision, and Values in behaviors, practices, and decisions. Provides operational management consistent with hospital and departmental mission statements, strategic and tactical plans.Revenue Management:Understands the integration between clinical activity and revenue management.Ensures the accuracy of documenting services and supplies provided to the patients.Assists in the preparation of annual department budget and monitors departmental performance to the budget and adjusts expenditures accordingly.Participates with SAHS Director in planning for expansion and program development of service line in accordance with strategic and tactical plans.Utilizes change management tools in identifying opportunities for patient care improvement.Participates in sourcing initiatives.  Negotiates with vendors and purchasing to maintain budget guidelines and provide cost-effective services.Assures compliance with all applicable SAHS and RHM policies and procedures, CHE Trinity Health system Case management Excellence Standards and maintains Joint Commission and other specific regulatory standards.Identifies best practices and implements innovative approaches to improve care.Participates on teams regarding care coordination efforts as appropriate.Fosters a collegial environment within and across service lines and maintains positive and productive working relationships with all relevant customers and suppliers.Facilitates and manages team performance to the established performance levels by effective use of performance improvement, human resources, and financial skills, techniques and communications.Manages/oversees RAC process/denials and UR committee functions.Serves as a role model, mentor, and consultant within the service line and to other clinical specialties as appropriate.

Our Commitment to Diversity and Inclusion
 

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

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