Manages the activities of hospital staff in inpatient care coordination and utilization review. Oversees interactions of staff with outside activities and agencies on regulations affecting patient status and insurance.
Collaborates and maintains positive working relationships with physicians, physician advisor and external review organizations to ensure quality outcomes, patient throughput, and appropriate resource utilization while supporting the HCH mission. Collaborates with the denials prevention and management staff to ensure a low medical necessity denial rate.
Supports the Mission of Trinity Health and Holy Cross Hospital.
Compensation: $3400 weekly with travel paid.
Minimum Licensure/Certification Required (if applicable):
State of Maryland license as a Registered NurseRN with BSN or RN with > 10 years case management experience. Masters Degree preferred.Minimum Knowledge, Skills, and Abilities Required:
At least 3 years of experience in hospital case management or related activityAt least 10 years clinical experience in an acute healthcare settingMinimum of 1–3 years management/supervision/leadership experience in an acute healthcare setting required, preferably with case management, utilization review or closely related area.Extensive knowledge of payer mechanisms and clinical utilization management is required. Knowledge of pertinent regulatory, accreditation, public and private service organizational activities relating to discharge planning and resource utilization. Evidence of prior successful interaction with external review organizations.Demonstrated ability to establish and maintain effective interpersonal relationships with all levels of personnel, medical staff, and community, as well as a demonstrated ability to work effectively with interdisciplinary teams.Demonstrated ability to lead through collaboration and influence.Reads, writes, speaks and comprehends the English language.Computer literacy and analytic skills required.Working Conditions:
Physical Requirements: Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.
Visual Acuity: The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading; visual inspection involving small defects, small parts, and/or operation of machines (including inspection); using measurement devices; and/or assembly or fabrication parts at distances close to the eyes.
Environmental Conditions: None. The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work.)
Management Statement:
Management at Holy Cross Hospital involves understanding that we operate within a fiduciary relationship in which we are expected to steward our community’s resources in such a way that we produce high quality, safe, efficient, and effective care for both today’s patients and tomorrow’s patients. This enables us to become the most trusted provider of health services within our community.
A Manager at Holy Cross Hospital is expected to demonstrate ethical behavior and support the mission of Holy Cross Hospital, while possessing and utilizing excellent analytical and monitoring skills, fiscal responsibility and the ability to select, train and retain line employees who are capable of creating a desirable work environment. Managers are expected to oversee 24-hour operations of their specific areas, ensuring the successful day-to-day function of the area, policy and objectives communication to staff, and that operational processes are staffed and monitored appropriately to ensure that quality, customer service, and financial performance are maintained.
In collaboration with the director, managers are responsible for establishing departmental policies and procedures and adapting them as necessary to meet operational objectives. In collaboration with the director, managers monitor their departmental results against budget, operational and strategic plans and determine how to improve performance against each. Effective cross-departmental cooperation and the ability to work with peers and the director and are essential to obtain the necessary agreements and resources needed to meet both area specific and organizational objectives.
Reporting Relationship:
Reports to and is evaluated by the Director, Care Management.
Supervisory Responsibilities:
In collaboration with the Director, Care Management is responsible for supervising and evaluating the Case Managers, Emergency Center Case Managers and PRN Case Managers.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.