Plans, organizes, and implements care management functions for BHMC. Provide supervision of all the Care Managers. Coordinate and support ongoing problem solving. Assist in establishing tools, processes, and systems to optimize Care Management's role.
Essential Functions & Accountabilities
1) Manages and oversees the care management functions for Bayhealth.
2) Prioritizes internal resources to meet the needs of patients according to risk level, regulatory requirements, and external resource capabilities.
3) Performs concurrent reviews to prevent denials, assuring appropriate communications and exchanged with physicians, related internal departments, and payers.
4) Identify urgent utilization issues and report them to the Director, unit management, and attending physician immediately.
5) Manage collection of Care Management/quality data according to pre-set criteria and standards for timeliness.
6) Manages Care Management clinical staff.
7) Maintains accurate budget data; monitors staff productivity.
8) All other duties as assigned, within the scope and range of job responsibilities
5 years clinical acute care experience
3 years supervisory and/or management experience in health-related field.
Supervision and/or management experience in Care Mgmt, Utilization Mgmt, or Performance Improvement
Current RN Licensure in DE or compact state
Certified in Health Care Quality (CPHQ), Utilization Mgmt, or Case Mgmt
Basic keyboarding skills with basic skills in Microsoft Word, or similar application
Working knowledge of Microsoft Word, Lotus Notes, Clinical data base software