Manager RN Case Management

Summary

Provides assessment, education and oversight for Case Management operations, including daily staffing, employee evaluations, staff coaching, orientation of new staff, and the identification and monitoring of performance metrics and competencies. Supervises and oversees case management in the areas of Clinical Documentation Improvement, and Transition Planning and Palliative Care. Monitors and remediates staff with regard to relevant software and processes. Serves as expert resource, educator, and liaison between Case Management, and other departments. Represents Case Management in hospital-wide committees and meetings, as well as within the wider healthcare community.

Essential Functions

Manages staff; interviews, hires and oversees onboarding team assignments. Provides guidance, training and delegates effectively to case management RN lead.

Assists in managing and developing department budget (s). Responsible for review and reconciliation of monthly expenses. Provides explanation of monthly variances in financial software and to director in monthly budget meetings.

Designs, and implements the monthly staffing plans and coordinates the daily plan with case management RN lead

Reviews feedback and based on findings prepares , organizes, and directs, programs for educating physicians, case managers, and as needed hospital staff.

Collects and aggregates data, on the results of auditing and monitoring activities related to case management goals and regulatory criteria.

Collaborates with other departments to meet the changing needs and priorities of the organization as well as Medicare Conditions of Participation.

Ensures compliance with state and federal requirements including Medicare Conditions of Participation.

Evaluates case management staff performance annually, ensures initial hire evaluations are completed in a timely manner, coaches and continually assesses learning needs of Case Managers with respect to documentation improvement, utilization of EPIC tools and patient interactions.

Provides direction for CM/MD rounds and support for staff as rounds launch or change in units

Maintain confidentiality and protects sensitive data at all times, including patient information, proprietary information and personnel information.

Minimum Qualifications

EDUCATION: Bachelor‘s degree in Nursing required. ACMA certification preferred.

EXPERIENCE: Five (5) years of RN experience, and two (2) years’ experience in Case Management, or related area with evidence of leadership, teaching and interpersonal skills, and documentation of professional development; management experience preferred.

LICENSURE OR CERTIFICATION: Current RN licensure permitting work in State of Arizona and Basic Life Support (BLS) required.

Knowledge, Skills And Abilities

• Thorough clinical knowledge of disease process.
• Knowledge of relation of DRG, ICD9 and CPT codes, relationship to physician documentation and insurance billing requirements.
• Knowledge of relevant laws, regulations, and safety requirements and standards.
• Knowledge of direct patient care and critical care procedures and techniques, tools, and responses required to ensure optimal patient care.
• Skill in communicating in a clear and concise manner with staff involved in critical care, and physicians to ensure the proper care of patients.
• Skill in evaluating cases and determining appropriate care and status.
• Ability to teach/train nurses and physicians in DRG Assurance and InterQual.
• Ability to read, analyze, and interpret hospital charts and to communicate effectively with hospital staff.
• Ability to generate, analyze, assess, and use organizational data to educate other professionals and improve and implement case management processes.
• Ability to develop and meet department and organizational goals.
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.