Manager Case Management, Full time

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Job Summary:

Serves as departmental Leader for the development, implementation and evaluation of care coordination, transitions in care and utilization review. Works in collaboration with Director Case Management, divisional OMG, Clinicians and care team members to develop and support evidenced based best practice. Ensures continued development of the program and employee engagement to promote quality care, measurable standards and best outcomes. Provides 24/7 accountability to support customers. Ensures continued development of the program and identification of opportunities for improvement.

Position Responsibilities:

Care Coordination - Facilitates the role of Case Management in activities associated with care coordination. Introduces new concepts to the role of Case Management for transitioning the patient through the continuum of care.

Resource Stewardship - Responsible for activities related to denials and excess day reduction including RCA, variance tracking and financial impact for department. Collaborate with healthcare team leader's methods to communicate processes to improve patient outcome, while reducing excess days and denials.

Maintains department operations including but not limited to budget, staffing, evaluations, competencies, mentoring and counseling, reporting (barrier report, monthly department activity, etc.)

Compliance - Demonstrate knowledge and understanding of state, federal and managed care regulations governing utilization management and patient rights. Maintains ongoing awareness of policies as related to managed care industry. Identifies and reports compliance issues as appropriate.

Participates and supports employee engagement and organizational activities, including HRO, patient satisfaction teams, six sigma teams, and community events.

Position Qualifications Required:

Required Experience:

Required:

Minimum 3 years UR/Case Management experience. Minimum 3 years clinical experience. Preferred 2 years of management experience.

Knowledge of applicable state, federal and third party regulations and standards (CMS Medicare/Medicaid, JCAHO, HRO, NCQA, HCFA).

Excellent verbal and written communication skills, critical thought, problem solving, organization and conflict resolution.

Understands budget/financial statements. Is able to identify and justify variances.

Ability to understand medical terminology and communicate effectively with persons of diverse backgrounds.

Required Education:

Graduate of approved Social Work Services program or accredited Nursing program.

Graduate of an accredited school with a Bachelors of Business Administration or equivalent. Masters preferred.

Training / Certification / Licensure:

NJ State Registered Nurse Licensure/Social Work Licensure

CCM - Certification in Case Management preferred