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Case Management Manager

3 months ago

Putnam, United States Day Kimball Healthcare Full time

Manager of Case Management & Utilization Review

32/40 hours, hybrid opportunity

Great benefits

Overview
Would you like to utilize your clinical expertise at the largest employer in northeast Connecticut known for its excellence in individualized care? We invite you to be a part of our team where you'll discover a culture of teamwork, professionalism, mutual respect, and most importantly, a life-changing career

Day Kimball gathers leading doctors, surgeons, therapists, researchers, nurses, and staff to work together for our patients' benefit. Our Nurse Managers - Case Management play a vital role in forging the path to excellence in patient care. They are committed to their patients and each other and have set the bar high in terms of team engagement, patient experience, continuous improvement, lifelong learning, quality clinical outcomes and commitment to patient and employee safety.

As the Manager of Case Management & Utilization Review, you will manage a multi-talented team responsible for facilitating the patient plan of care throughout the continuum of care by ensuring appropriate utilization management, care coordination, resource utilization, and clinical documentation.

Summary of Responsibilities

  • Provide management direction to the RN Case Managers/assigned clerical and utilization management staff in the department
  • Identify appropriate staffing levels, assignments and deployments for the department and monitor performance criteria for staff members
  • Review operations of the Case Management department to ensure high level of quality is consistent with organization standards
  • Provide leadership through education on case management/utilization management concepts, committee work, research, and community involvement
  • Facilitate the patient plan of care throughout the continuum of care by ensuring appropriate utilization management, care coordination, resource utilization, and clinical documentation
  • Assist with collecting, analyzing, evaluating, and presenting clinical management and operations data to the Leadership Team for achieving the overall goals and objectives of the department and the organization
  • Act as primary liaison between providers, patients and families, members of the interdisciplinary team, and outside agencies to assure high-quality care that meets the patient's needs and is delivered in a cost-effective and timely manner
Knowledge, Skills, and Abilities
  • In-depth understanding of anatomy, physiology medical terminology and disease processes
  • Knowledge of CPT coding, resource management systems, electronic medical record, and basic computer skills
  • Demonstrated leadership, independent problem solving, conflict resolution, critical thinking skills, and team building skills
  • Self-motivated and able to work as part of a diverse team with minimal supervision
  • Ability to work well within a creative and challenging work environment is
  • Experience in utilization review, ability to navigate medical records, value-based purchasing metrics, or pre-certification
  • Exceptional team orientation; strong sense of commitment to team members and patient impact
  • Additional nursing experience in specialty area is preferred
Qualifications
  • Registered Nurse (RN) or Master's in Social Work (MSW)
  • A minimum of three (5) years of experience in Case Management is preferred
  • Additional specialty certification/training as required by the work area