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 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  

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.  

Education: 

• Bachelor of Science Nursing or Social Work (required)  

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

 
Licensure/Certification: 

Experience: 

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

Training: 

None 

Skills and Abilities: 

Hard/Tech/Clinical Skills:  

• Care management  

• Discharge planning  

• Patient Advocacy  

• Flexible  

• Care Planning  

• Care Coordination  

• Analyzing data or information  

• Reimbursement methodologies  

• Staffing workflow and bed allocation  

• Clinical knowledge  

• Tracking  

• Working knowledge of local and state resources  

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement  

Soft/Interpersonal Skills:  

• Leadership  

• Mentorship  

• Training Employees  

• Knowledge Sharing  

• Attention to detail  

• Critical thinking  

• Communication with family members  

• Conflict resolution  

• Proactive