60531 - Manager Care Management-RN (wvumedicine)

Job Description

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This position is responsible and accountable for the day to day operation of the care management program. The components/roles of the care management program consist of the following: care facilitation, utilization management, care management, discharge planning, and transitions of care.

This position is responsible for assisting with developing systems and processes for care/utilization management at the hospital. In addition, the incumbent is responsible for managing the department’s day to day activities related to discharge planning and clinical quality improvement. The incumbent evaluates and ensures that hospital resources are used appropriately and effectively. The incumbent assists with the collection, analysis, and reporting of financial and quality data related to utilization management. The incumbent must demonstrate the ability to lead and inspire their employees and to motivate them to execute a plan in a rapidly changing environment. The incumbent promotes interdisciplinary collaboration, fosters teamwork, and champions service excellence.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelors of Science Degree in Nursing.
2. Current unencumbered licensure with the WV Board of Registered Professional Nurses, or appropriate state board where services will be provided, as a registered professional nurse OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
EXPERIENCE:
1. Five (5) years of registered nursing experience with two (2) years in a supervisory role.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Master’s degree.
2. Care Management Certification upon hire or obtained within one (1) year of hire.
EXPERIENCE:
1. Experience with InterQual and MCG criteria.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Manages all aspects of the day to day operations of the care management program.
2. Manages personnel to ensure the availability of an appropriately credentialed, clinically competent, well developed cohesive work force to meet patient care needs.
3. Advises the Director on the hiring, retention, interviewing and recruitment of staff.
4. Initiates and maintains appropriate personnel records.
5. In conjunction with the supervisors and clinical preceptors, hold scheduled meetings as needed to evaluate the progress of staff on orientation.
6. Performs on-going written performance reviews and any necessary employee action plans according to hospital policy.
7. Provides ongoing feedback to employees concerning job performance in a professional and constructive manner. Counsels and disciplines employees, under the direction of the Director.
8. Monitors on a continual basis the operating budget, providing information and/or justification of variances to the Director in a timely manner.
9. Makes recommendations to the Director and assists with the preparation of the Capitol and Operating budget for his/her cost center annually.
10. Assists in the verification and validation of payroll reports, intervening as appropriate to ensure adherence to institutional payroll policy and procedures.
11. Assures the most economical utilization of time, materials and resources through the review of workflow and staffing patterns in order to achieve optimal productivity and to provide cost effective staffing patterns that ensure appropriate utilization of staff and skill mix.
12. Spends funds in dollar amounts which are congruent with the department’s budget and is reflective of cost containment.
13. In conjunction with the supervisors, reviews denials, appeals, avoidable days, and employee audits in order to develop improved processes.
14. Maintains effective communication with Medical Staff, patients/families, staff, and other departments as necessary to assure identification of problems and provide timely problem resolution in support of the hospital's mission of quality patient care delivery.
15. Participates in the development, review, and communication of policies and procedures ensuring information is available for staff in a timely manner and monitors for compliance.
16. Serves as resource liaison for governmental regulations, and ethics/healthcare law
17. Serves on various hospital committees as needed or assigned.
18. Communicates employee concerns to Director, as applicable.
19. Improves and maintains management skills by participating in self-development activities such as seminars, workshops, classes and literature review.

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. Prolonged periods of standing or sitting. 

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1. Flexible hours to include weekends and holidays.
2. Requires the ability to take call on a rotational basis.

SKILLS AND ABILITIES:

1. Possesses excellent interpersonal communication and negotiation skills in interactions with patients, families, physicians, and healthcare team colleagues.
2. Ability to work with people of all social, economic, and cultural backgrounds and be flexible, open minded, and adaptable to change.
3. Demonstrates expert team building skills, problem solving abilities, and conflict resolution strategies.
4. Knowledge of leading practice in clinical care and payer requirements.
5. Knowledge of payer mechanisms, clinical utilization, discharge planning and transitions of care.

Additional Job Description:

Scheduled Weekly Hours:

0

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

UHA University Health Associates

Cost Center:

403 WVUH Care Management

Address:

WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.