Case Management Manager
Category: Management
Facility: Genesis Healthcare System
Department: Case Management
Schedule: Full Time
Shift: Day Shift
Hours: 80 bi-weekly / 8a - 4:30p
Job Details:

JOB SUMMARY

Responsible for developing, planning evaluating and coordinating comprehensive patient care across the continuum, to enhance quality patient care while simultaneously promoting cost effective resource utilization.  Monitors patient care, which includes utilization, quality assurance, discharge planning, continuity of care, and case management activities.  Coordinates and monitors activities with appropriate members of the health care team to promote efficient use of hospital resources, facilitate timely discharges, prevent and control infections, promote quality patient care and reduce risk and liability.  Analyze and trend data results in order to incorporate efforts and information results with existing systems to optimize efficiency of operational systems through strategic quality leadership.  Investigates and initiates follow up on utilization denials, contract negotiations, external regulatory agencies’ requirements and participates in education seminars and opportunities.

 

ESSENTIAL DUTIES

1.       Responsible for identifying tracking mechanisms in order to evaluate and achieve optimal financial outcomes, to enhance quality patient care and promote cost effective resource utilization.

2.       Uses data to drive decisions, plan and implement performance improvement strategies for case management.

3.       Coordinates daily activities of the Case Management Department in order to promote quality patient care, efficient use of hospital resources, facilitate timely and adequate discharges and reduce risk and liability.

4.       Actively serves on hospital committees and teams and facilitates opportunities for employees to do the same.

5.       Develops, performs and improves personal and departmental knowledge of computer software and reporting functions.

6.       Organizes and oversees the maintenance of denial and appeal activity.  Follows-up with physicians and others when indicated.

7.       Prepares or coordinates the preparation of periodic and special reports required by various agencies, insurance contracts and for hospital committees.

8.       Facilitates growth and development of the case management program, in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities, as needed.

9.       Develops new resources where gaps exist in the system as identified through research and data analysis to meet and enhance the quality/efficiency of comprehensive patient care and/or basic human needs for the community.

10.    Interact with Corporate Consulting and Business office on issues such as contracting, billing, reimbursement, denials and physician reports cards, collaboratively initiates improvements related to these areas.

11.    Maintains hospital compliance with the Quality Improvement Organization (QIO) and CMS guidelines. 

 

QUALIFICATIONS 

1.          Current licensure as a registered nurse by the State of Ohio.  Bachelor’s degree in nursing required.

2.          3 years of management or demonstrated leadership experience required.

3.          Knowledge of prospective payment systems, managed care, infection control surveillance, patient care, disease processes, discharge planning and continuum of services offered within Genesis and externally. 

4.          Ability to perform data analysis and to utilize computer systems to record and communicate information to other services. 

5.          Excellent leadership, verbal and organizational skills to order to steer the case management process.

 

WORKING CONDITIONS/PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1.       Must have excellent written and verbal communication skills as well as the ability to observe, access, guide and evaluate others. 

2.       Must be able to hear, speak, see and to coordinate motor skills.

3.       Must be able to climb, lift25 pounds, stoop and bend. 

4.       Ability to collect data, interpret findings, set priorities and carry out established plan. 

5.       Ability to read, write and utilize manual and computerized systems of documentation.

6.       Must read a significant amount of information in a relatively short period of time. 

 




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