State licensure as a Registered Nurse (RN) required
Preferred: Master's degree in Nursing
Preferred: 2 years of leadership experience
Preferred: Management experience in case management or acute care nursing
BLS certification required before start date
Responsibilities
Assist in developing departmental goals and objectives aligned with the organization's strategic plan
Monitor and analyze utilization management data and trends
Engage in community outreach for effective patient management
Manage staff relations, including performance and conflict resolution
Oversee departmental budgets, compliance, and vendor relations
Assess and coordinate quality patient care services
Support the denials process with clinical reviews and payer communications
Benefits
Opportunities for professional development and continuing education
Supportive work environment focused on teamwork and collaboration
Access to advanced healthcare technology and resources
Engagement in community health initiatives
Comprehensive health and wellness programs
Full Job Description
Summary
Responsible for carrying out the day-to-day operations related to care management, under the direction of the Senior Director, with a focus on efficient delivery of care and effective transitions between care settings. Assist in tracking data, noting trends, and identifying improvement opportunities through staff observations, chart reviews and other means.
Job Duties
Assists the Sr. Director with developing specific departmental goals, standards, and objectives which directly support the strategic plan and vision of the organization
Assists Sr Director with development and monitoring of UM data, data trending and acts as Committee coordinator
Assists with community outreach and relations for optimal patient management
Manages staff relations including performance management, staff satisfaction and conflict management. Performs and oversees scheduling, recruitment, and student engagements
Monitors departmental budgets, regulatory compliance, departmental contracts and vendor relations. Determines and justifies needs for systems/equipment/supplies purchases, monitors usage, and oversees proper working order and/or stock supplies
Assesses the quality of patient care delivered and coordinates patient care services with patients, staff, physicians, and other departments. Manages complaints and conflicts through to resolution.
Assists with the denials process with focus on clinical reviews, peer-to peer reviews, payer communications, tracking and other duties related to denials and denials prevention.
Educates and orients staff. Acts as a subject matter expert to collegues.
Other duties as assigned.
Requirements
Bachelor's degree in Nursing
2 years of related experience
State licensure as a Registered Nurse (RN)
Preferred: Master's degree in Nursing
Preferred: 2 years of experience in leadership activities
Preferred: Experience in management, with subject matter expertise in the area of case management (acute or ambulatory); utilization and acute care nursing
BLS through the American Heart Association or the American Red Cross CPR for the Professional Rescuer with card in-hand before start date.
Leadership Skill Requirements:
Maintain and Model Respect, Excellence, Accountability, Compassion and Honor.
Action and Results-Oriented: Ability to establish key goals, drive and track results among multiple decision-makers and stakeholders and meet deadlines in a fast-moving environment.
Political Savvy and Diplomacy:
Ability to maneuver through complex, politically charged situations and understand the dynamics and culture of the organization.
Ability to anticipate problems and negotiate solutions with peers, senior leadership, and other key stakeholders.
Ability to Build Relationships Through Integrity and Trust
Ability to quickly gain the trust and respect of others, drive collaboration, build a teamwork environment, search for the win/win scenarios.
Influencing Skills: Ability to lead an organization using influence, rather than possessing direct authority of others, being sensitive, yet direct in both verbal and written communications.
Managing Complexity: Ability to lead and drive results in a complex organization, achieving alignment between often-conflicting priorities, initiatives and people.
Functional/Technical Skills Requirements:
Comprehensive understanding of operational health care delivery systems and the current health care landscape. Skills and experience with developing competitive business strategies for health care. Skills and experience with the operational aspects of health care technology deployment. Familiarity and comfort with technology-based operational improvement. Health care management or consulting experience preferred.
Analytics and Strategy: Expertise in developing and executing data-driven approaches to enhancing business decision-making and improving operational performance (preferably in healthcare). Advanced knowledge of business intelligence best practices, familiarity with fact-based management tools and techniques to drive strategies and a continuous improvement culture.
Communications: Excellent written and verbal communications skills. Ability to take abstract, complex and/or technical information and break it down for a variety of audiences in a way that is meaningful for them.
Functional Oversight: Issue identification, gap analysis, ability to prioritize business needs and execute solutions.
Financial Management: Ability to understand financial reports, develop basic financial models, and identify trends, variances, and opportunities
