Lead Case Manager
The Lead, Nurse Case Manager RN provides clinical group leadership and expert technical guidance to the Nurse Case Manager RN/Care Coordinator team. The incumbent in this role also promotes consistent application, effective processes and clinical service accountability and is responsible for all the functions below on a smaller number of patients.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Provides structure and assure consistent implementation of the CM plan, DM plan, SOPs and policies in all centers.
- Assists with creation and implementation of SOPs as appropriate.
- Precepts new case managers.
- Serves as resident CM and DM “expert” to consistently support CM needs for market specific education.
- Provides support for catastrophic cases within the clinical support group.
- Identifies problems or any dissatisfaction experienced by patients or referring source and works to resolve them to a high degree of service excellence.
- Builds relationships with preferred acute care providers (hospitalists, specialists).
- Attends meetings that require CM/DM participation relay information as needed to other market case managers.
- Assigns coverage for CM PTO/Open positions.
- Assists with quality audits; Analyzes case management/disease management outcomes to identify issues and make recommendations.
- Formulates, implements and evaluates educational strategies for staff, patient and family.
- Floats to other centers as needed.
- Inputs into case manager performance evaluations or direct supervisory authority as determined by market leadership.
- Assists in the interviewing, hiring and termination of case management staff.
Other responsibilities may include:
- Assists with quality audits and data analyses to identify opportunities for improvement.
- Supports quality improvement initiatives.
- Serves as a resource for CM/DM process and documentation.
- Assists with patient complaints and follows to resolution.
- Performs other duties as assigned and modified at manager’s discretion.
KNOWLEDGE, SKILLS AND ABILITIES:
- Analytical ability and comprehensive knowledge base to identify opportunities for improvement and problem resolution, evaluate patient status and health care procedures/techniques, and monitor quality of patient care.
- Verbal and written communication skills to communicate effectively with diverse populations including physicians, employees, patients and their families.
- Knowledge of care delivery capabilities along the continuum of care.
- Interpersonal skills necessary to work productively with all levels of hospital personnel and to supervise the activities of a group of employees. Strong interpersonal, communication and critical thinking skills are required.
- Resourcefulness to identify prompt and sustainable solutions to barriers in care delivery.
- Leadership skills to direct others toward objectives that contribute to the success of the department.
- Ability to cope with stressful situations, manage multiple and sometimes conflicting priorities simultaneously.
- Flexibility with schedule, including off-shifts, weekends and holidays to meet the needs of patients, families or staff.
- Teaching abilities to conduct educational programs for staff.
- Fiscal skills to monitor and control costs and revenue.
- Familiarity with professional and technical emerging knowledge.
- Problem solving skills and ability to multi-task.
- Compassionate with teamwork skills.
- Ability to supervise and train employees, to include organizing, prioritizing, and scheduling work assignments.
- Excellent knowledge of case management principles, healthcare management and reimbursement.
- Previous experience with psychological aspects of care.
- Excellent organizational and time management skills.
- Proficient in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software.
- Ability and willingness to travel locally, regionally and nationwide up to 10% of the time.
- Spoken and written fluency in English.
- Bilingual preferred.
Additional Job Description
EDUCATION AND EXPERIENCE CRITERIA:
- Associate degree in Nursing required.
- Bachelor Degree in Nursing (BSN) or RN with Bachelor Degree in a related clinical field, highly desired.
- A valid, active Registered Nurse (RN) license in State of employment required.
- A minimum of 5 years’ clinical work experience required.
- Proven working experience in Case Management:
- A minimum of 3 years’ utilization review and/or case management, home health and/or discharge planning experience required. (These 3 years can be included in the 5 years clinical work experience requirement).
- Case Management Certification through the Commission for Case Manager Certification (CCMC) or the American Association of Managed Care Nurses (CMCN) preferred.
- Hospital, healthcare setting experience is preferred.
- Leadership experience in a healthcare setting highly desired (lead nurse, charge nurse, nursing supervisor, etc.)