Manager, Care Management (Full-time/On-site)

ZipRecruiter; Chicago (IL); On-site; USD 70,000 - 110,000; Full time

Job summary

An established industry player is seeking a Manager of Care Management to lead and supervise utilization review and case management activities. In this pivotal role, you will ensure patients receive the right care at the right time while maximizing resource utilization and compliance with external requirements. You will direct a team of case managers and social workers, implement effective care transition strategies, and maintain crucial records for administrative purposes. This position offers a unique opportunity to make a significant impact on patient care and operational efficiency in a dynamic healthcare environment.

Qualifications

• 3-5 years of experience in care management or utilization review.
• Current IL RN License or LCSW licensure is required.

Responsibilities

• Lead interdisciplinary teams to ensure optimal patient care.
• Direct and supervise case managers and social workers effectively.

Skills

Leadership

Strategic Planning

Communication

Problem Solving

Utilization Review

Education

Bachelor’s degree

Master’s degree

Tools

Utilization Management Software

Job description

Job Description

Position Summary:

The Manager Care Management leads, plans and supervises activities of utilization review/case management function involved in following patients throughout the continuum of care to ensure optimum utilization of resources, service delivery and compliance with external requirements.

Essential Duties and Responsibilities:

• Leads interdisciplinary efforts to ensure patients receive the right care at the right time. This includes ensuring InterQual criteria is determined to maximize proper bed utilization to enhance access to care and maximize revenue streams as appropriate.
• Directs, plans and supervises activities of case managers and social workers in following patients throughout the continuum of care. This includes strategic planning and daily management of operations related to case management for all inpatient units; ensure optimum utilization of resources, service delivery and compliance with external requirements.
• Leads integrated efforts to implement effective care transition strategies that reduce length of stays and readmission rates.
• Plans, schedules and organizes work for staff ensuring proper distribution of assignments and efficient utilization of personnel, space and facilities; directs the requisition, care and maintenance of department inventory.
• Participates in multidisciplinary team meetings regarding the planning and implementation of patient care; facilitates communication and problem solving related to discharge planning.
• Maintains required records, reports and statistics for administrative purposes; ensures compliance with established hospital policies, procedures, objectives, performance improvement, safety, environmental and infection control practices.
• Maintains liaison with physicians, hospital administration and ancillary department managers to analyze unit needs, identify problems and effect change as needed to improve services.
• Determines fiscal requirements of department and prepares budget.
• Directs various personnel actions including, but not limited to, hiring, performance evaluations, disciplinary actions and scheduled time off.
• Investigates over and underutilization cases, implements corrective action and reviews all denial letters for reconsideration appeal.
• Implements and supports HPH’s strategic priorities and quality initiatives while ensuring regulatory compliance.
• Participates in the Utilization Management Committee and provides monthly statistical activity report.
• Implements and supports quality initiatives in the department and ensures regulatory compliance.

Qualifications:

• Minimum 3-5 years of experience
• Bachelor’s degree, Master’s degree
• Must have current IL RN License or LCSW licensure