MAJOR FUNCTION: 

Responsible for the day-to-day case management operations of each care center, including oversight of interdisciplinary rounds as needed. Responsible for staff mentoring and professional development, including recognition and counseling of all case management staff. Tracking and monitoring outcomes in collaboration with Department director. Outcomes include but are not limited to length of stay, readmission, denials, patient satisfaction, and patient rights items. Assist in tracking and reporting patient rights metrics, including patient preference, Important Message from Medicare and Medicare Outpatient Observation Notice. Monitor adherence to department policy and procedure. Serves as resource to case managers and other interdisciplinary staff regarding case management role, responsibility, and procedure. Monitors staff attendance. Coordinates with department secretary to review and approve timesheets and PTO requests. Monitors and oversees new staff orientation and evaluation. Completes case management staff yearly evaluations. Maintains clinical competency and current knowledge of regulatory and payor requirements to perform job responsibilities independently. Weekend on-call rotation is required

QUALIFICATIONS: 

Education & Experience: 

BSN required. MSN preferred.  Management experience preferred.  Must have minimum 10 years of healthcare experience within last 15 years.  Minimum 5 years case management and utilization review experience in past 7 years.  Ongoing experience with physician and clinical staff practice patterns and operational issues. 

Certification/ Licensure: 

Licensed Registered Nurse in New Jersey required.  Case Management Certification preferred.

Knowledge & Skills: 

Must have knowledge of MCG criteria and understanding of Centers for Medicare & Medicaid Services (CMS) guidelines. Understanding of the revenue cycle and UM process. Proficiency in Microsoft Office.  Ability to work independently, setting priorities to coordinate care plans efficiently and effectively. Ability to handle potentially adversarial situations with composure and diplomacy; aptitude to complete thorough follow-through. Capability to work as part of a team to improve care transition and overall patient experience.  Ability to coordinate, compile and analyze data.  Demonstrates excellent communication skills (oral and written) and interpersonal skills necessary to converse with families, patients, vendors, third-party payors and staff for optimum care.  Physical Requirements: 
N: Never       O: Occasionally (<20%)       F: Frequently (20%-80%)       C: Constantly (>80%) Lifting <20lbs   O Standing   F Sitting     C Lifting 20-50lbs   N Climbing   O Kneeling    N Lifting>50lbs   N Crouching   N Reaching    O Carrying   O Hearing   C Walking    C Pushing   O Talking   C Vision    C   Environmental Conditions: Noise   F Varied Temperatures   F Cleaning Agents   O Noxious odors   O Patient Exposure   F Operative Equipment   O