Manager - Case Management RN

The Manager for Hospital Case Management is a registered professional nurse and case management expert responsible for the planning and oversight of daily operations, as well as the development of the case management team.

Responsibilities include partnership with physician leader(s) and other members of the care team to facilitate effective coordination of clinical care and utilization management.

Manager will oversee initial and continued stay level of care reviews using approved criteria, discharge corrdination to achieve quality care and best financial outcomes, and denials and appeals across the healthsystem.

The manager performs supervisory duties including but not limited to: Human resource management, coordination of new staff orientation, competency monitoring and development, daily operations of all staff, policy development, performance evaluation and developmental planning as directed.

Job Responsibilities

1) Serves as a knowledgable clinical and case management expert: Assists Director with recruitment and hire of new staff, opertional support to existing staff, oversight and supervision of hospital case management functions. Demonstrates exceptional communication and collaboration within and across departments. Develops relationships with key constituents to facilitate teamwork and successful collaboration to execute results.

2) Assist with staff accountabilities and development: care coordination; resource management; discharge planning; utilization management; department productivity targets.

Is actively involved in the day to day process, as needed: participant on daily rounds with HCMs, patient care meetings, and reviewing cases with prolonged LOS. Evaluation of cases regarding level of care with Denials and Appeals Coordinator and individual case managers.

Serves as a change agent and professional role model to lead team to embrace a newly designed comprehensive case manager role, championing care coordination, medical and utilization management. In partnership with AD leads implementation of InterQual /risk severity assessment.

3) Works with the CM educator to provide education to elevate case manager performance to meet national contemporary standards of practice. Provides support to Case Management staff on HINN, ABN, IM, MOON, level of care and regulatory requirements of discharge facilitation, care coordination and utilization. Serves as a mentor and presents in-services as needs are identified or requested. Obtains national certification and works with team to do same over next 12-24 months.

4) Works with the CM educator to update, develop and maintain the yearly programatic competency requirements. Insures staff compliance with annual competency requirements

5) Recruits and hires staff in partnership with AD. Provides direct observation and assessment of performance. Provides timely feedback to improve staff performance to develop individuals/team. Conducts annual performance reviews.

6) Works collaboratively within and across teams to assess and manage clinical, utilization and financial outcome data evaluating innovative solutions to drive results. Assists in creating case management performance dashboard to report results.

7) Assists Director to lead change and execute strategic plan to implement contemporary case management model. Drives and supports development of case management program and integration and partnership with other clinical services.

8) Assists the Director to research best practices and develop and/or update departmental policies to reflect contemporary practice.

9) Identifies prospective candidates from varied healthcare background to grow a diverse and talented team. Interviews and hires in partnership with Director. Plans and coordinates competency-based orientation.

10) Identifies appropriate patients for in complex care rounds, coordination of weekly rounds with key stake holders. Works in partnership with physician leader, nursing and other colleagues to identify best options for care management and post acute care transition.

Required Work Experience

• 1) Minimum 5 years clinical nursing experience
• 2) Three years Case Management experience required
• 3) Previous supervisory and team development skills strongly preferred

Preferred Work Experience

1) None listed

Skills and Competencies

1) Requires a working knowledge of coordination of clinical care, discharge planning, community resources utilization management, quality review standards, activities conducted by third party payers and regulations

• 2) Ability to organize and prioritize workload in order to meet deadlines
• 3) Must possess excellent interpersonal skills in order to interact with all levels of health care providers, support staff, and third party payers where appropriate
• 4) Demonstrated leadership capabilities and education skills

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range.

Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

• Minimum - Midpoint - Maximum
• $130,977.00 - $150,550.00 - $178,048.00

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.