Purpose:
The Manager oversees the day-to-day operations of the Case management department under the direction of the Director. The Manager is accountable for the following Case Management functions: training, auditing, systems support: Case Management Technology, InterQual, Concurrent Denials and reporting. Leads efforts to develop, implement, evaluate, redesign and modify Case Management practice standards. Works closely with the Case Management staff in an effort to safely, effectively and efficiently move patients across and through the continuum of care.

Responsibilities:

Develops reporting tools to assist Director and executive leadership teams to assess the effectiveness of Case Management efforts. Collaborates with other UPMC departments to establish mechanisms to address issues related to care management, tracks, trends avoidable day/delay documentation and reports to Director trends/barriers. Analyzes data for trends related to variation in actual vs. targeted length of stay. Collaborates with other staff to develop performance improvement activities as indicated. Oversees daily operations of the Case Manager (CM) staff under the direction of the Director. Conducts employee performance reviews. Utilizes identified denial trends to develop training tools to facilitate maximum financial reimbursement. Monitors and mentors Case Management staff. Develops and implements processes for timely and accurate documentation of appropriate data relating to concurrent denials. Collaborates with other departments to generate outcome data as needed to measure and trend performance indicators. Coordinates with Case Management in an effort to meet the established length of stay targets. Coordinates with Case Management staff to ensure safe/effective/efficient plans of care are implemented Conducts inter rater reliability audits per established policy. Ensures training programs address identified needs of Case Management staff Assists with management of departmental budget. Collaborates with Director, Medical Director/Physician Advisor and staff to ensure effective processes and systems are established and maintained to meet department goals. Participates in leadership development. Functions as a resource person for the care management and denial management processes. Coordinates daily flow of the department (this includes overseeing PTO requests, assignment coverage, weekend coverage) Takes a leadership role in the mentoring and monitoring of documentation expectations in Case Management technology. Analyzes data for trends and causative factors that promote or impede progression toward positive care management outcomes.