Case Management Supervisor

Montefiore · $135,000–$140,000 (stated in the posting)

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Responsible for supporting and coordinating hospital-wide Care Management Program to ensure the delivery of high quality, cost effective care through collaborative relations with physicians, care managers, patients/family, insurance carriers and other member of the health care team. Directs appropriate length of stay decisions based on knowledge of State, Federal and Third Party regulations to decrease LOS, perform transitions of care and initiate timely discharges. In addition to the day-to-day responsibilities, the Supervisor, Care Management will work in conjunction with the Director of Care Management on a variety of critical tasks including the management of one or more focused clinical initiatives.

B.   Essential Job Qualification

       1.    Education: Graduate from an accredited School of Nursing or college. BSN Required. MSN or MPA Preferred.

       2.    Experience: 2-3 years’ experience in hospital utilization review and or managed care. 5 years’ experience in an acute care setting or equivalent experience. 1-3 of management experience preferred. Strong problem solving skills required.

       3.    Training/Certification: Case Management certification preferred.

       4.    Licensure: Current New York state RN license required.

       5.    Other: Knowledge of DOH, JCAHO and Peer Review Organization requirements. Knowledge of PC based systems to assist in data analysis. Ability to communicate (written and verbal) effectively with medical and administrative staff in a positive, assertive, and professional manner. Self-motivated, self-directed, well organized with excellent interpersonal skills required. Demonstrated competency knowledge and ability to effectively care for the adult geriatric patient population.

C.  Job Specific Contacts

       1.    General Contacts: Frequent communication with management, medical staff, department heads, home care, finance, support staff and board members. Contact with outside review organizations, insurance companies, nursing homes, assisted living/adult homes, rehabilitation facilities and regulatory agencies.

Job Provides oversight to:  RN and Social work care managers, Administrative assistant and Clerical Coordinator

D.  Environment and Demands

       1.    Environmental Demands: Normal office environment

       2.    Essential Physical and Cognitive Demands, Manual Dexterity: Manual dexterity for computer work, concentration for report preparation, analysis of QI issues and customer sensitivity in dealing with complaints.

Part I: Hospital-Wide Standards

A.    Organizational

Demonstrates adherence to Montefiore Nyack Hospital “We Care” standards including:

WORKING TOGETHER        

“I will commit to work together in a courteous, respectful manner.  I will demonstrate a positive spirit of service with all employees with whom I interact.”

• Place team success above individual recognition.
• Be receptive to new ideas and approaches within my workplace.
• Offer assistance generously without hesitation.

EMPOWERMENT

“I will be accountable, responsible, and self-directed in all aspects of my work at all times.”

• See projects through to ensure completion.
• Problem solve with patients, family members, and other employees.
• Follow up to ensure a resolution.

COMMUNICATION

“I will demonstrate positive communication in a clear, courteous and appropriate manner at all times.”

• Answer the phone within three rings if possible and identify myself, my department, and ask, “How may I help you”?

• Use effective verbal and written communication to patients, families, visitors, using the principles of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank You)
• Use positive communication in my tone of voice, body language, and choice of words.
• Respond to e-mails in a courteous manner, with-in twenty-four hours.

APPEARANCE

“I will dress in a manner that reflects a professional and positive image of the hospital at all times”

• Maintain a clean, neat, and professional appearance which adheres to the hospital dress code policy.
• Promote and adhere to Montefiore Nyack Hospital's guidelines regarding a safe and clean work environment for employees, patients, families and visitors.

RESPONSIVENESS

“I will demonstrate the ability to provide timely feedback and communication to patients, visitors, and coworkers.”

• Respond to patient call lights and ask if I can assist. (No Pass Zone).

• Respond empathetically.
• Apologize for delays and concerns.

EXCELLENCE IN SERVICE

“I will strive to ‘do my best everyday’ in exceeding customer expectations.”

• Anticipate and address my patients’, families and visitors needs.
• Avoid negativity and exhibit a “can-do” attitude.
• “Manage up” fellow employees, physicians, departments, and the organization, to increase patient confidence both internally and in the community.
• Exit elevators to accommodate our patients’ first.
• Acknowledge people in the hallway by smiling and making eye contact.
• Help lost guests and new employees by escorting them to their destination.

B.   MISSION/STRATEGIC PLAN:

Demonstrates support of the Mission and Strategic Action Plan through the initiation and ongoing implementation/evaluation of department activities/plans.

C.  JOB-SPECIFIC COMPETENCIES:

Demonstrates the technical/professional knowledge, skills, and abilities necessary for the successful operations of the department including, where applicable, age specific competency.*

Supports and manages the procedures and goals of the case management department. Maintains positive relationship with external vendors, and providers.   Oversee staff that process referrals, authorizations, billing, utilization review and capitation for hospital services. Supervises Care Managers in the management of patients across the continuum of patient care, from the patient’s entry into the health care system, until the appropriate outcome is achieved. Ensure that all Care Management team members are properly and adequately trained and that they have the skills and abilities to perform the required functions. Develop and implement on-going training related to Care Management and ensure the appropriate tools are available for implementation of policies and procedures. Collaborates with care management leadership and works closely with all appropriate internal departments to resolve complex issues related to care management and social management of patients Identify areas for improvement in existing operational policies and procedures, develop recommendations for departmental senior management; and follow through with the implementation. Directs appropriate length of stay discharge decisions based on knowledge of State, Federal and Third Party regulations.

• Monitors and audit’s documentation from care managers
• Assist with scheduling and daily oversight of care managers
• Monitor performance and provides feedback

Monitors system to ensure that admission to the hospital is appropriate and patient achieves length of stay targets and is referred to the appropriate setting in a timely manner. Develops quality improvement indicators which will evaluate patients who are high cost, high resource users, frequent readmissions to the hospital, determination of patient/family/provider satisfaction, decreased fragmentation of care, identification and resolution of system barriers. Actively communicates the outcome of the review process with Patient Financial Services and other disciplines as needed. Conduct facility wide education on a periodic basis related to LOS initiatives and mentoring Manages activities related to overturning adverse determinations. Will provided floor coverage as needed during periods of staffing changes under direction of care management leadership Continuous collaboration and touch base with care management leadership Other functions as required to support departmental activities

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