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Clinical Case Manager RN

2 months ago

Louisville, Kentucky, United States Baptist Health Full time
Job Summary

The Case Manager Registered Nurse is responsible for the overall development and management of the Cooperative Care Program at Baptist Health. This role requires a strong clinical background and experience in case management.

Key Responsibilities
  • Develop and continuously evaluate the Cooperative Care Program for cost-effective, quality outcomes.
  • Maintain knowledge of current and future trends in the health care environment, including payer policies and requirements.
  • Responsible for utilization management activities of the department.
  • Develop effective relationships with physicians, corporate leadership, and other parties who interact with the case management department.
  • Attend designated medical staff meetings.
  • Ensure accuracy of all data gathered and analyzed in the department.
  • Serve as a hospital liaison to third-party payers.
  • Identify practice patterns that can lead to quality and utilization improvement.
  • Facilitate compliance with regulatory agency standards.
  • Assist with preparation and compliance of annual capital, expense, and FTE budgets.
  • Participate in recruitment/retention efforts, including interviewing and hiring new staff.
  • Responsible for supporting and utilizing quality performance improvement concepts.
  • Provide leadership and serve as a professional resource to ensure development of excellence within the department.
  • Develop staff and patient education and orientation programs related to CCP functions.
  • Exhibit creativity in devising new approaches for complex problems.
  • Demonstrate diplomatic interactions with internal and external customers.
  • Facilitate good communication with employees.
  • Complete administrative functions in the absence of the director.
  • Maintain confidentiality of patient and physician-related information.
Requirements
  • Active Kentucky RN license required.
  • Minimum of five years clinical experience and five years of case management experience.
  • CCM required.
  • Previous management experience required.