Primary Function/General Purpose of Position
The Manager, Care Management is responsible for day-to-day oversight, coordinating, organizing and managing functions and resources for the Care Management Department. This role collaborates and coordinates with Care Management Leadership and colleagues to achieve standardization of assigned functions and responsibilities. This role combines the clinical and the financial components to achieve the best possible outcomes for the patients served and the organization.
This is the manager of Case Management department for both Kings Mills Hospital and Clermont Hospital
Essential Job Functions
Provides leadership and oversees day-to-day operations to Care Management Team. Works with Care Management leadership and colleagues to achieve standardized practices and processes related to Advance Care Planning, LOS management, readmission prevention, use of predictive readmission tool and application of appropriate interventions, denial prevention related to medical necessity through proactive progression of care and addressing barriers to (including tracking of avoidable days or delays), daily team rounding, care transitions, patient satisfaction related to care transitions. Monitors success through qualitative and quantitative data and takes appropriate action to mitigate barrier and improve outcomes.
Advocates and educates regarding right care, right time at the right place. Provides education to care management staff, physicians and nursing, other care teams members regarding effective progression of care, LOC, and safe and timely transition management. Supports national standards for care management scope of service: Education, Care Coordination, Compliance, Transition Management and Resource Utilization.
Utilizes systems within the Care Management Department to support an effective and proactive care management process across the continuum, working closely with and aligns with population health and community health efforts supporting a patient-centered care management model that spans the continuum. Collaborates with ambulatory and post-acute providers and staff to ensure seamless transitions of care.
Partners with physician leader to optimize the Utilization Management Committee, providing actionable data related to utilization opportunities identified through qualitative data and quantitative data analytic platforms such as Quality Advisor and other facility or system resources.
Directs daily operations to achieve effective utilization of personnel resources consistent with patient and ministry needs. Assist in development of annual departmental goals and objectives, aligns with system Care Management goals and objectives. Assists in development of strategic departmental plans and initiatives. Fosters integration and strong collaborative partnerships with nursing, quality, hospitalist, physician advisor, other physician leadership in supporting and engaging in clinical integration activities in order to optimize high quality, cost efficient care.
Participates in the development and management of the annual budget. Identifies and achieves cost reductions. Works in concert with organization colleagues to achieve standardization of operations. Understands the financial impact of contracts and changing payment models from fee-for-service to value-based care. Works collaboratively with staff and other key stakeholders to reduce cost
Models professional conduct with Care Management leadership, staff, and all customers. Takes initiative to educate self and staff on the changing healthcare landscape including fee-for-service to value-based models, care model innovations, research and leading evidenced based practices. Promotes and models service excellence behaviors and educates others in service excellence principles. Exhibits flexibility and enthusiasm in style and can adjust to constantly changing economic, technical and strategic shifts. Ensures compliance with federal, state, and local regulations and accreditation requirements impacting care management service.
This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.
Licensing/Certification
BLS Basic Life Support – American Heart Association (required)
Current RN License in the state in which they are working or covered by compact (preferred)
Social Work licensure (preferred)
Education
Bachelor of Science Nursing or Social Work (required)
Masters, Nursing, Social Work, or Healthcare Administration (preferred)
Work Experience
3 years of recent acute hospital care management experience (required)
Training
None
Language
None
Patient Population
Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.
Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures.
Pediatrics (1-12 years)
Adults (18-64 years)
Geriatrics (65 years and older)
Working Conditions
Periods of high stress and fluctuating workloads may occur.
Long-distance or air travel as needed- not to exceed 10% travel.
General office environment.
May be exposed to high noise levels and bright lights.
May be exposed to physical altercations and verbal abuse.
May be exposed to limited hazardous substances or body fluids.*
May be required to use physical restraints.
May be exposed to human blood and other potentially infectious materials.*
May have periods of constant interruptions.
Required to car travel to off-site locations, occasionally in adverse weather conditions.
Prolonged periods of working alone.
* Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.
Physical Requirements
Physical Demands
Frequency 0% 1-33% 34-66% 67-100%
Lifting/ Carrying (0-50 lbs.) X
Lifting/ Carrying (50-100 lbs.) X
Push/ Pull (0-50 lbs.) X
Push/ Pull (50-100 lbs.) X
Stoop, Kneel X
Crawling X
Climbing X
Balance X
Bending X
Work Position
Frequency 0% 1-33% 34-66% 67-100%
Sitting X
Walking X
Standing X
Additional Physical Requirements/Hazards
Physical Requirements
Manual dexterity (eye/hand coordination)
Perform shift work
Maneuver weight of patients
Hear alarms/telephone/audio recordings
Reach above shoulder
Repetitive arm/hand movements
Finger Dexterity
Color Vision
Acuity – far
Acuity – near
Hazards
Depth perception
Use of Latex products
Exposure to toxic/caustic/chemicals/detergents
Exposure to moving mechanical parts
Exposure to dust/fumes
Exposure to potential electrical shock
Exposure to x ray/electromagnetic energy
Exposure to high pitched noises
Gaseous risk exposure
Many of our opportunities reward* your hard work with:Comprehensive, affordable medical, dental and vision plans
Prescription drug coverage
Flexible spending accounts
Life insurance w/AD&D
Employer contributions to retirement savings plan when eligible
Paid time off
Educational Assistance
And much more
*Benefits offerings vary according to employment status
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com