Case Management Supervisor - Full Time - Days

Mohawk Valley Health System; City of Utica (NY); Sur place; USD 81 000 - 131 000; Plein temps

Résumé du poste

Mohawk Valley Health System is seeking a Case Management Supervisor to oversee the case management staff, coordinate utilization review, and ensure quality, efficient care for our diverse member population. You will mentor staff, supervise daily operations, and ensure compliance with MLTC and regulatory requirements.

Responsibilities include guiding the interdisciplinary team, providing education, identifying over-utilization, and driving quality improvement.

Qualifications

• Must hold NY RN license with Bachelor’s in Nursing or health-related field, or NY-licensed SW.
• 3-5 years Case Management experience.
• Prior supervisory experience.
• RN with 1 year medical-surgical experience if RN.

Responsabilités

• Oversee the Case Management function and daily operations.
• Coordinate utilization review practices and ensure accurate documentation.
• Provide education and training to Case Management staff.
• Identify over-utilization and report trends to leadership.
• Ensure adherence to regulatory requirements and patient rights.

Formation

Registered Nurse license (New York)

New York State Licensed Social Worker

Bachelor’s Degree in Nursing or health-related field

Description du poste

Job Summary

The Case Management Supervisor is responsible for the oversight of the case management staff’s authorization/coordination/utilization and provision of member services. Duties include the supervision and mentoring of the case management staff to ensure quality, efficient and comprehensive care to our diverse member population. Provides direct oversight of the case manager’s daily operations of utilization review practice, process and procedures ensuring accurate member care needs are met and documented per the managed long term care program (MLTC) insurance regulations.

Core Job Responsibilities

• Coordinates the daily work within the Case Management function. Relays and distributes work assignments and monitors work for quality and completeness.
• Ensures that the Case Management team works effectively and efficiently with the interdisciplinary health care team to meet patient, departmental and organizational goals.
• Provides education and training as needed to assist with the day to day operation of the Case Management department.
• Assists with identifying over-utilization of services and reports trends to Case Management leadership.
• Ensures that the Case Management team adheres to Conditions of Participation and all regulatory requirements that impact patient rights.
• Engages in quality improvement initiatives including continuing education, participation in system wide and unit specific teams, identifying nursing practice areas for quality improvement and safe outcomes; maintains a cooperative relationship among the health care team by communicating information; responding to requests; building rapport; participating in team problem solving.
• Provides service excellence to patients and their families/visitors that meets or exceeds patient expectations through offering empathetic and compassionate patient-centered care; professionally manage patients, families and care givers as needed and concerns using positive service recovery methods; Responds to patient/family requests and makes active referrals to subject matter expert/decision maker who can fulfill patient requests; Provide culturally sensitive care.
• With leadership and Human Resources guidance, provides input to or makes recommendations on employee hires, performance reviews, transfers, promotions, salary changes, disciplinary actions, terminations and similar actions. Resolves grievances and other staff problems in a fair, timely and consistent manner also in conjunction with HR.
• If working as a Registered Nurse, practices in accordance with New York State Practice Act and applicable regulatory standards.
• Ensures understanding and compliance with all MVHS policies and procedures and regulations.
• Performs related duties as assigned.
  

Education/Experience Requirements

Required:

• Registered Nurse licensed in State of New York, Bachelor’s Degree in Nursing or health-related field required, or New York State licensed Social Worker.
• If a Registered Nurse, must have a minimum of 1 year medical surgical experience.
• 3-5 years Case Management experience
• Prior supervisory experience.
  

Licensure/Certification Requirements

Required:

• Registered Nurse licensed in State of New York, Bachelor’s Degree in Nursing or health-related field required, or New York State licensed Social Worker.
• Licensed and currently registered to practice as a Registered Nurse in New York State, or Licensed and currently registered to practice as a Licensed Clinical Social Worker in New York State.
• Valid New York State driver's license.

Disclaimer

Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.

Successful candidates might be required to undergo a background verification with an external vendor.

Job Details

Req Id 99216
Department CASE MGMT
Shift Days
Shift Hours Worked 8.50
FTE 1
Work Schedule SALARIED GENERAL
Employee Status A1 - Full-Time
Union Non-Union
Pay Range $81,000 - $131,000 Salary