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Manager- Case Management

Milwaukee, WI
Manager – Care Management
Direct Hire
Milwaukee WI- 53226
Details of Job:
  • The Manager, Care Management/Care Transitions oversees the day-to-day operations and performance management of RN Case Managers, Utilization Review Case Managers, Denials Coordinators, and Case Management Specialist staff for the Care Management & Care Transitions department.
  • Plans, organizes, evaluates and manages hospital acute care case management, discharge planning, and utilization management functions including patient assessment, discharge care planning, counselling, transition management, admission management, medical necessity, and patient outcome evaluation.
  • Performs all functions in accordance with all federal, state, and local regulations and scopes of practice for the nursing profession.
  • Serves as an expert resource on laws, policies, and operational procedures.
  • Analyses available data to measure individual and department performance, clinical program performance, department processes, and compliance. Works in conjunction with the Director, Care Management/Care Transitions on a variety of critical tasks including the management of one or more focused clinical initiatives.
  • Develops, analyses, updates, and monitors metrics for care management initiatives.
  • Assists in budget development and maintenance.
  • Plays an integral role in representing the company externally in presentations with key provider and member groups and provides oversight to those provider
  • groups that are delegated for clinical functions.
  • Develops and maintains cooperative working relationships with other hospital departments and outside agencies to coordinate provision of medical care and transitions through the care continuum.
  • Develops and implements policies and procedures that integrate State and federal regulations to ensure compliance with government agency requirements. Other duties as assigned.
  • Five years of related experience within care management & care transitions with progressively more responsible work experience necessary to gain full knowledge of care management objectives and practices, and acquire administrative skills necessary to lead and direct
  • departmental personnel is required.
  • In addition to minimum experience requirements, three years of leadership experience in a hospital setting is strongly preferred
  • Acute Care RN case management experience and/or utilization management experience using MCG is strongly desired.
  • Demonstrated commitment to excellent customer service.
  • Understands health care delivery and what is required for an integrated care continuum for diverse patient populations. Excellent interpersonal skills required to communicate and collaborate productively and professionally with both internal and external customers.
  • Proven process improvement skills. Exceptional analytical skills and critical-thinking abilities. Ability to concentrate and focus attention on details for up to 80% of work time when interviewing patients, preparing discharge plans, and performing management functions, such as budgeting, analysing, scheduling, and statistical reporting.
  • Degree in Nursing (Baccalaureate or Graduate) is required (Graduate degree in Nursing or Related Field is preferred.)
  • Requires current state of Wisconsin Registered Nurse License or Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact). Accredited Case Manager (ACM) certification per the ACMA (American Case Management Association) is required within one year of hire or transfer.
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