Job Summary and QualificationsThe RN Case Manager Lead provides guidance, consultation, education, and training to case management staff, ensuring quality medical care is delivered in a cost-effective and appropriate manner while maintaining a patient-focused approach. This role provides clinical leadership and supervision for the RN Case Management nursing staff, contributing to the development and implementation of a seamless continuum of care model.
What will you do in this role: - Provide clinical leadership and supervision to RN Case Management staff. Contribute to the development and implementation of a comprehensive, system-wide continuum of care.
- Oversee and coordinate activities related to utilization management and payer contract issues.
- Participate in departmental leadership meetings and contribute to the evaluation of Case Management services.
- Collaborate with other departments and community organizations to improve care coordination and reduce readmissions.
- Contribute to the development of the Case Management work plan.
- Ensure appropriate staffing levels and on-call coverage.
- Represent the Case Management Department on committees.
- Provide planning for vacations or coverage in the event of illness of staff members.
- Assume responsibility when case managers are unavailable.
- Oversee and coordinate department activities involved in resolving all PRO and payer contract utilization management issues.
- Review and interpret PRO and payer contracts and transmittals, and disseminate information accordingly and educate Case Managers.
- Educate and assist Case Managers in resolving denials of care issues.
- Coordinate and facilitate Admission and Patient Accounts information to ensure optimal reimbursement for care rendered.
- Participate in departmental leadership meetings and on-going evaluation of the quality and scope of Case Management services.
- Serve as conduit for communicating strategic medical management information between staff and administration.
- Keep the Department Director informed of significant operational trends, systems barriers, and/or developments.
- Provide consultation to staff on cases involving difficult practice issues.
- Provide resource management advice and expertise to various groups and committees.
- Maintain productive relationships with on-site external Case Managers, VNAs, SNFs, and other vendors.
- Oversee the communication strategy with the patients and/or their families, physicians, and payers regarding potential insurance non-coverage and medical management issues.
- Assist case managers with complicated cases.
- Participate in the orientation and continuing education needs of all new staff members.
- Identify and interpret clinical needs of patients for appropriate case management.
- Utilize information technology to improve workflow for the department.
- Collaborate with CMC Primary Care Practice Care Coordinators to develop systems to identify and monitor care coordination across the CMC and community continuum.
- Collaborate with Department Leaders to identify strategies to reduce readmissions and appropriately utilize health care resources.
- Participate in the identification and development of the measures of success for the Case Management program.
- Participate in the evaluation of clinical and financial data/outcomes.
- Maintain continuous knowledge of clinical nursing practice policy, procedure and protocol.
- Act as liaison in the development of collaborative relationships within the community, the alliance, and with contracted payers.
- Contribute to the on-going development of information and data services.
- Assume responsibility for the management of the department as delegated by the Department Director and/or in the absence of the Department Director.
- Provide ongoing, positive feedback and constructive criticism to staff.
- Participate in the selection process of candidates for employment.
- Participate in disciplinary and other actions to be taken regarding personnel matters.
- Assist the Director with the performance evaluation process.
- Participate in the development of scientific research, professional publication and presentations.
What qualifications you will need:- Basic Cardiac Life Support must be obtained within 30 days of employment start date
- New Hampshire (RN) Registered Nurse license or active compact state RN license needed to begin employment. New Hampshire single state RN license required within 60 days of beginning of employment.
- Associate Degree in Nursing required, Bachelor's Degree preferred/
- Active New Hampshire RN license or active compact state RN license.
- 3 + years of case management experience preferred.
BenefitsPortsmouth Regional Hospital, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:
- Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
- Wellbeing support, including free counseling and referral services
- Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
- Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
- Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
- Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location. 
