Manager of Care Management

2 weeks ago

Tacoma, Washington, United States The National Coalition of Healthcare Recruiters Full time
33.6 miles South from Seattle

(Only QUALIFIED Healthcare Professionals accepted)

Case Manager-RN - Manager of Care Management
Seattle | Bellevue | Everett, Washington
JO# 24860

General Summary:


The Manager of Care Management leads and manages the day-to-day operations of utilization, clinical resource and case management departments and focuses on the continuum of care for the patient population.


  • Develops case management programs that allows the hospital(s) to meet clinical resource management goals as well as third party and regulatory standards.
  • Manages and educates staff at all levels about effective clinical resource management. Provides formal and informal programs.
  • Maintains effective working relationships and effectively communicates the goals and objectives of the program to the medical staff, department staff, and others within and outside the hospital.
  • Evaluates the effectiveness of existing clinical protocols and pathways and makes recommendations for new ones.
  • Promotes organizational mission statement and goals and empowers staff and peers to achieve outstanding performance.
  • Effectively reports departmental activities, goals, and measures of success.
  • Works effectively with MCO staff and leadership to decrease denials or downgrades in reimbursement.
  • Maintains department standards for regulatory and accreditation purposes.
  • Actively seeks to resolve those issues brought forward by medical staff that have an adverse effect on patient outcomes.
  • Analyzes the issues for cost|benefit in terms of improving clinical and financial outcomes.
  • Prioritizes and recommends effective approaches that will improve clinical and financial outcomes in the hospital.
  • Primary liaison between Case Management and the hospital Quality Committee.
  • Recommends plans of care for high profile DRGs that incorporate effective Case Management strategies.

Experience:

  • At least 3+ years Nursing Management experience in an acute care setting required
  • Hospital Case Management experience required
  • Managed Care Organization (MCO) experience preferred

Education:

  • Bachelor of Science in Nursing (BSN) required
  • Master's Degree in Nursing or a related healthcare field preferred

Certifications|Licensures:

  • Registered Nurse License required
  • Certified Case Manager (CCM) a plus, not required
  • Healthcare Quality of Utilization Review (HQUR) a plus, not required

Special Skills:

  • Advanced communication and interpersonal skills
  • Analytical and quantitative analysis skills
  • Ability to lead a complex department to reach and exceed goals
  • Ability to work with other departments
  • Knowledge of Managed care trends, Medicare and Medicaid regulations
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