Healthcare Case Management Leader
2 weeks ago
Position Summary
The Case Management Supervisor is responsible for overseeing patient care coordination throughout the healthcare continuum. This role includes managing clinical documentation improvement (CDI), utilization oversight, social services, and discharge planning to enhance patient outcomes efficiently. The supervisor ensures optimal resource utilization and assists in the development and management of all Case Management programs while adhering to regulatory standards.
Key Responsibilities:
- Coordinate and facilitate staff orientation and training initiatives.
- Evaluate and document the effectiveness of training programs, reporting findings to the Case Management Director.
- Design and deliver educational sessions for Medical Staff and Nursing personnel on CDI, Utilization Review (UR), Discharge Planning (DCP), Social Services (SS), and other Case Management strategies.
- Monitor staff caseloads and treatment plans to guarantee timely and effective care delivery in compliance with departmental protocols.
- Collaborate with the Director of Case Management to develop staff performance evaluations.
- Generate reports to track departmental outcomes, trends, and issues, submitting these to the Case Management Director.
- Work closely with medical providers and leadership to interpret and guide program initiatives.
- Revise operational policies and procedures to enhance program effectiveness.
- Participate in regular staffing meetings with clinicians and case management teams.
- Conduct weekly meetings with coding specialists to resolve discrepancies in coding interpretations.
- Regularly update the Case Management Director on departmental activities.
- Engage with medical staff regarding patient status and care levels.
- Attend departmental meetings and contribute to agenda preparation and minute-taking.
- Facilitate Multidisciplinary Rounding (MDR) sessions.
- Provide support for status and care level reviews using MCG/InterQual guidelines.
Additional Duties:
Other responsibilities may be assigned as needed.
Supervisory Responsibilities:
Assume direct supervision of the Case Management Department in the absence of the Director.
Qualifications:
- Bachelor's degree in Nursing is required.
- Experience and proficiency in MCG/InterQual guidelines.
- Familiarity with Electronic Medical Records (EMR) systems such as Cerner, Epic, or MedTech.
- Proficient in Microsoft Office Suite.
- A minimum of 3-5 years of experience in acute care hospital case management is required.
- At least three years of administrative or supervisory experience in case management within an acute care setting is essential.
Licenses and Certifications:
- Active, unencumbered Registered Nurse license in California is required.
- Certification as a Case Manager (CCM) is required within one year of employment.
Population Served:
Newborn, Infant, Pediatric, Adolescent, Adult, Geriatric, All.
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