Manager of Care Management - Tacoma, United States - The National Coalition of Healthcare Recruiters

Description

The Manager of Care Management leads and manages the day-to-day operations of utilization, clinical resource and case management departments and focuses on the continuum of care for the patient population.

• Develops case management programs that allows the hospital(s) to meet clinical resource management goals as well as third party and regulatory standards.
• Manages and educates staff at all levels about effective clinical resource management. Provides formal and informal programs.
• Maintains effective working relationships and effectively communicates the goals and objectives of the program to the medical staff, department staff, and others within and outside the hospital.
• Evaluates the effectiveness of existing clinical protocols and pathways and makes recommendations for new ones.
• Promotes organizational mission statement and goals and empowers staff and peers to achieve outstanding performance.
• Effectively reports departmental activities, goals, and measures of success.
• Works effectively with MCO staff and leadership to decrease denials or downgrades in reimbursement.
• Maintains department standards for regulatory and accreditation purposes.
• Actively seeks to resolve those issues brought forward by medical staff that have an adverse effect on patient outcomes.
• Analyzes the issues for cost|benefit in terms of improving clinical and financial outcomes.
• Prioritizes and recommends effective approaches that will improve clinical and financial outcomes in the hospital.
• Primary liaison between Case Management and the hospital Quality Committee.
• Recommends plans of care for high profile DRGs that incorporate effective Case Management strategies.

• At least 3+ years Nursing Management experience in an acute care setting required
• Hospital Case Management experience required
• Managed Care Organization (MCO) experience preferred

• Bachelor of Science in Nursing (BSN) required
• Master's Degree in Nursing or a related healthcare field preferred

• Registered Nurse License required
• Certified Case Manager (CCM) a plus, not required
• Healthcare Quality of Utilization Review (HQUR) a plus, not required

• Advanced communication and interpersonal skills
• Analytical and quantitative analysis skills
• Ability to lead a complex department to reach and exceed goals
• Ability to work with other departments
• Knowledge of Managed care trends, Medicare and Medicaid regulations