Manager Care Managment & Util Review

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Job Description Summary:

This position has accountability for the daily operations and supervision of the Case Management program and /or Social Services Staff under their assigned cost center(s). Thus, this position is responsible for the supervision of all case managers, social workers, and any ancillary support or contingent staff including hiring, performance evaluation and accountability, scheduling, and disciplinary actions. Similarly, he/she is responsible for assisting the Director of UR/Case Management to assure Departmental Performance achieves the objectives of the Hospital's Utilization Management Plan as well as other Department and/or Campus specific indicators/targets for quality, employee satisfaction, customer satisfaction and financial targets as well as practice methodologies consistent with continued process improvements. This position provides clinical/administrative coverage in the absence of Department managers/directors and works collaboratively with other managers within this department and across campuses with an overall goal of meeting hospital needs related to assigned areas. He/She will also provide education and consultation with physicians and/or other clinical areas as appropriate to assure overall program clinical expertise and best possible patient outcomes.

Responsibilities And Duties:

Note:  weight of responsibility may shift depending on campus/department location & staff size. (i.e.: emphasis may be more on managing staff around population health or discharge planning vs. UR/UM)

50% Provides Direct Supervision of care managers, social workers, utilization review case managers, extenders, supervisors and ancillary support staff at locations as applicable.
1. Establishes and maintains efficient and productive work schedules and assignments.
2. Hires in concert with the Director, all associates for the department.
3. Conduct performance evaluations for all pertinent staff.
4. Addresses any performance issues with assigned staff.
5.  Provides oversight for training, development, and engagement of associates.

20% Proactively manages those campus/department services which facilitate the efficient delivery of healthcare to patients across the continuum of care to improve the health of a population, ensure safe transitions and increase patient engagement.
1. Provides education/updates on clinical management of specific patient populations’ coordination of care, discharge planning, process improvement process, and third party payer utilization criteria for appropriate level of care.
2. Develops and implements strategies for efficient and effective care management operations.
3. Acts as liaison with appropriate campus and system departments to increase efficiency and accuracy in management of specific patient populations in regards to clinical management, coordination of discharge planning and process improvement.
4. Assures the efficient operation of the three primary areas of operational responsibility: care management, discharge planning and utilization review.

20% Proactively manages the utilization review process
 Develops and implements strategies for efficient and effective communication with third party payers ensuring timely communication meeting industry standards. Develops and implements strategies for efficient and effective communication with third party payers ensuring timely notification of admission and discharge meeting industry standards Act as a liaison with Managed Care, Revenue Cycle, Managed Care Payers and denial agency to ensure proper processing of claims and payments. Provide education regarding medical necessity process and transition in the continuum. Implement education for associates regarding third party standards for level of care.         

10% Develops and implements pertinent Process Improvement Initiatives:
1. Assists in development & implementation process improvement initiatives which are ongoing.   
2. Develops and promotes patient engagement through assessment and process improvement activities.
3. Promotes innovations leading to improvements in quality, patients experience and safe transitions across the continuum of care.


As a High Reliability Organization (HRO), responsibilities require focus on safety, quality and efficiency in performing job duties.  

The job profile provides an overview of responsibilities and duties and is not intended to be an exhaustive list and is subject to change at any time

Minimum Qualifications:

Master's Degree (Required)RN - Registered Nurse - Ohio Board of Nursing

Additional Job Description:

SPECIALIZED KNOWLEDGE

Experience working with multidisciplinary teams or complex groups in a facilitation or coordination role, knowledge of Process Improvement tools and proficient use of Microsoft Office products. 

Work Shift:

Day

Scheduled Weekly Hours :

40

Department

UM Care Coord-South Central Hu

Join us!
... if your passion is to work in a caring environment
... if you believe that learning is a life-long process
... if you strive for excellence and want to be among the best in the healthcare industry

Equal Employment Opportunity

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment