Manager, Case Management

Edison, NJ, United States

Overview

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Manager of Case Management , is responsible for all activities related to Case Management, Social Work and Utilization Management, including, but not limited to discharge planning, medical necessity, and denial prevention. Ensure transition management promoting appropriate length of stay, readmission prevention and patient satisfaction. Provide Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care; and education provided to physicians, staff, patients, families and caregivers. Promotes collaboration with all appropriate departments to meet identified goals.

Responsibilities

A day in the life of a Manager of Case Management at Hackensack Meridian Health includes:

Serves as a key participant in the design, implementation and monitoring of the case management program.

Leads the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement.

Participates in the budgetary planning and execution for the Case Management department with emphasis on monitoring expenditures in supplies, equipment, staffing, and cost control measures.

Establishes a collaborative relationship with physicians, medical directors, nurses and other unit staff, and payers.

Collaborates with physicians to understand medical practice issues.

Participates in the development of department policies and procedures and process improvements.

Serves as representative and resource for community and regional services appropriate for the continuity of care post-hospitalization. Includes, but not limited to, home health agencies, long term care, rehabilitation facilities, medical equipment companies and medical transport companies.

Seeks assistance of physician advisors/liaisons, appropriate Chair and/or Vice Chair to assure compliance with correct patient status, timely discharges/transfers in accordance with length of stay criteria.

Trends data and identifies opportunities to improve current practice. Manages department operations to assure effective throughput and reimbursement for services provided.

Directs day to day operations ensuring compliance with regulatory requirements. Monitors and implements legal compliance measures.

Ensure medical necessity review processes are completed accurately and in compliance with CMS regulations.

Ensure timely and effective patient transition and planning to support efficient patient throughput.

Develops and implements an integrated process for the functions of Care Coordination, Social Work and Utilization Review which includes working collaboratively with other disciplines.

Implements and monitors processes to prevent payer disputes.

Tracks and trends data to identify areas for denial prevention.

Develop and provide physician education and feedback on hospital utilization.

Ensure compliance with state and federal regulations and Joint Commission accreditation standards.

Refers cases identified as risk management issues, peer review issues, or quality issues to the appropriate team members.

Monitors patient and family satisfaction through system approved measures, participates in the development and monitoring of any departmental quality initiatives.

Works with department supervisors to determine and monitor workload productivity standards for team members.

Identifies trends and performance improvements. Coordinates training based on identified need.

Has the authority to evaluate, hire, counsel (using established disciplinary process) and terminates team members in accordance with Human Resource policies.

Evaluates performance of team members and completes performance appraisals.

Maintains knowledge of regulatory and professional standards and communicates these standards as needed.

Adheres to the standards identified in the medical center's organizational and managerial competencies.

Ensures that CM staff provides clinical information to the appropriate payer source as required or requested through approved HIPAA and confidential methods in a timely manner to facilitate financial coverage of the hospitalization and to avoid denials of coverage.

Exhibits clear communication skills with all internal and external customers. Maintains standards of behavior in interactions with all customers, coworkers, patients, visitors, physicians, volunteers, etc.

Qualifications

Education, Knowledge, Skills and Abilities Required :

Bachelor's degree in Nursing or a Master's degree in Nursing, Social Work or related field

Certification or eligible in 2 years.

At least 5 years full time experience in an acute care setting.

Familiar with hospital resources, community resources, and/or resource/utilization management.

Care coordination, case management, discharge planning and/or utilization review experience.

Effective decision-making /problem-solving skills, demonstration of creativity in problem-solving, and influential leadership skills.

Excellent verbal, written and presentation skills.

Moderate to expert computer skills.

Education, Knowledge, Skills and Abilities Preferred :

Minimum of 2 years of experience in Nursing Leadership.

3-5 years previous experience in Case Management.

Extensive knowledge of medical necessity and EPIC.

Working knowledge of the financial aspects of third party payers and reimbursement.

Licenses and Certifications Required :

NJ State Professional Registered Nurse License or NJ Licensed Clinical Social Worker or NJ Licensed Social Worker.

Case Management certification by a nationally recognized organization within 1 year.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

#J-18808-Ljbffr