Manager, Case Management
2 days ago
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. MSN/MS in related field OR enrolled within 1 year of hire & complete within 3 years of enrollment 3 YOE required; 3 YOE in Care Management, 1 YOE in leadership Licensure, Certifications, and Clearances: Current licensure as a Registered Nurse in practicing state required. UPMC approved Care Management certification or agreement to obtain upon hire required. Behavioral Dimensions:1. Current knowledge of medical care/treatment, The Joint Commission Standards, Federal/State regulations relative to utilization/case management, discharge planning, Medicare, Medicaid, and other third party payor requirements, and managed care principles preferred. Use of expert clinical practice, leadership skills, and critical thinking skills to efficiently coordinate and direct patient care among all health care providers while maximizing use of resources is required. The ability to prepare and critically analyze data, make appropriate recommendations toward resolution, and follow-through of identified action is required. Expertise in interpersonal relationships, organizational relations, and effective communication, negotiation, and conflict resolution skills are required. The motivation and drive to work independently with minimal supervision to pursue continuous development of self and others are required. Strong sense of commitment and of being in control of ones practice is needed. Ability to effectively resolve practice issues and facilitates practice changes within the organization and throughout the continuum of care is required. Ability to foster principles of participative management by identifying/involving relevant individuals in program-related decisions is required. Ability to apply creative and innovative approaches to develop and maintain systems that achieve higher levels of multi-disciplinary team performance and desired patient outcomes is needed. Registered Nurse (RN) *Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state. UPMC is an Equal Opportunity Employer/Disability/Veteran
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