Manager Case Management Multiple Locations

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Scheduled Weekly Hours:

Work Shift:

Mercy Health

The Manager Care Management is responsible for day-to-day oversight coordinating organizing and managing functions and resources for the Care Management Department. This role collaborates and coordinates with Care Management Leadership and colleagues to achieve standardization of assigned functions and responsibilities. This role combines the clinical and the financial components to achieve the best possible outcomes for the patients served and the organization.

Essential Job Functions

• Provides leadership and oversees day-to-day operations to Care Management Team. Works with Care Management leadership and colleagues to achieve standardized practices and processes related to Advance Care Planning Length of Stay (LOS) management readmission prevention use of predictive readmission tool and application of appropriate interventions denial prevention related to medical necessity through proactive progression of care and addressing barriers to (including tracking of avoidable days or delays) daily team rounding care transitions patient satisfaction related to care transitions. Monitors success through qualitative and quantitative data and takes appropriate action to mitigate barrier and improve outcomes.

• Advocates and educates regarding right care right time at the right place. Provides education to care management staff physicians and nursing other care teams members regarding effective progression of care Level of Care (LOC) and safe and timely transition management. Supports national standards for care management scope of service: Education Care Coordination Compliance Transition Management and Resource Utilization.

• Utilizes systems within the Care Management Department to support an effective and proactive care management process across the continuum working closely with and aligns with population health and community health efforts supporting a patient-centered care management model that spans the continuum. Collaborates with ambulatory and post-acute providers and staff to ensure seamless transitions of care.

• Partners with physician leader to optimize the Utilization Management Committee providing actionable data related to utilization opportunities identified through qualitative data and quantitative data analytic platforms such as Quality Advisor and other facility or system resources.

• Directs daily operations to achieve effective utilization of personnel resources consistent with patient and ministry needs. Assist in development of annual departmental goals and objectives aligns with system Care Management goals and objectives. Assists in development of strategic departmental plans and initiatives. Fosters integration and strong collaborative partnerships with nursing quality hospitalist physician advisor other physician leadership in supporting and engaging in clinical integration activities in order to optimize high quality cost efficient care.

• Participates in the development and management of the annual budget. Identifies and achieves cost reductions. Works in concert with organization colleagues to achieve standardization of operations. Understands the financial impact of contracts and changing payment models from fee-for-service to value-based care. Works collaboratively with staff and other key stakeholders to reduce cost

• Models professional conduct with Care Management leadership staff and all customers. Takes initiative to educate self and staff on the changing healthcare landscape including fee-for-service to value-based models care model innovations research and leading evidenced based practices. Promotes and models service excellence behaviors and educates others in service excellence principles. Exhibits flexibility and enthusiasm in style and can adjust to constantly changing economic technical and strategic shifts. Ensures compliance with federal state and local regulations and accreditation requirements impacting care management service.

This document is not an exhaustive list of all responsibilities skills duties requirements or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor subject to reasonable accommodation.

Licensing/Certification

• BLS Basic Life Support American Heart Association (required)

• RN License in state of practice or Licensed as a Social Worker in state of practice (required SW license preferred in VA)

• Accredited Case Manager Certification (ACM) from American Case Management Association or Certified Case Manager (CCM) from Commission for Case Manager Certification or American Nurses Credentialing Center (ANCC) Nursing Case Management board certification (preferred)

Education

• Bachelor of Science Nursing or Social Work (required)

• Masters Nursing Social Work or Healthcare Administration (preferred for BSMH required for RSFH)

Work Experience

• 3 years of recent acute hospital care management experience (required)

Mercy Health is an equal opportunity employer.

As a Mercy Health associate youre part of a Misson that matters. We support your well-being personally and professionally. Our benefits are built to grow with you and meet your unique needs every step of the way.

What we offer
Competitive pay incentives referral bonuses and 403(b) with employer contributions (when eligible)
Medical dental vision prescription coverage HAS/FSA options life insurance mental health resources and discounts
Paid time off parental and FMLA leave short- and long-term disability backup care for children and elders
Tuition assistance professional development and continuing education support

Benefits may vary based on the market and employment status.

Department:

It is our policy to abide by all Federal and State laws as well as the requirements of 41 CFR 60-1.4(a) 60-300.5(a) and 60-741.5(a). Accordingly all applicants will receive consideration for employment without regard to race color national origin religion sex sexual orientation gender identity age genetic information or protected veteran status and will not be discriminated against on the basis of disability. If youd like to view a copy of the affirmative action plan or policy statement for Mercy Health Youngstown Ohio or Bon Secours Franklin Virginia; Petersburg Virginia; and Emporia Virginia which are Affirmative Action and Equal Opportunity Employer please email . If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process please contact The Talent Acquisition Team at .