Manager, Case Management & Social Services

Bay Area Hospital; Coos Bay (OR); On-site; USD 100,000 - 140,000; Full time

Job summary

Bay Area Hospital in Coos Bay, OR is seeking a Manager of Case Management & Social Services to lead the Case Management and Social Services teams, oversee discharge planning, utilization management, and transitions of care. Work with physicians and leadership to coordinate patient care.

The role focuses on patient-centered care, regulatory compliance, and improving patient flow and outcomes while managing budgets and staffing.

Qualifications

• Demonstrated knowledge of acute-care case management and discharge planning.
• Ability to coach, develop, and hold staff accountable.
• Experience analyzing clinical and operational data to identify trends.

Responsibilities

• Provide operational and clinical leadership for Case Management, Social Services, discharge planning, and care coordination.
• Identify barriers to care and facilitate timely transitions of care.
• Collaborate with physicians, nursing leaders, and other teams to improve patient outcomes.
• Develop budgets, staffing plans, and resource utilization.
• Promote interdisciplinary care planning and patient-centered care.
• Ensure compliance with CMS COP and payer requirements.

Skills

Acute-care case management knowledge

Leadership skills

CMS requirements knowledge

Data analysis

Critical thinking

Job description

Manager, Case Management & Social Services

Current Bay Area Hospital Employee: If you are a current Bay Area Hospital employee, The future looks bright at Bay Area Hospital, and we are always searching for quality people to join our team. We offer a great atmosphere, competitive pay, a wide array of benefits, and many growth opportunities for our employees.

Job Description:
Manager, Case Management & Social Services

Time Type: Full time

Hours per Pay Period: 80

Shift: Day Shift

Minimum: Depending on Experience

Maximum: Depending on Experience (This represents the rate for an individual with significant experience in this job in a full-time 40 hour per week position)

Department: Case Management

Job Description: Manager Case Management & Social Services The Manager of Case Management & Social Services provides operational and clinical leadership for Case Management, Social Services, discharge planning, utilization management, transitions of care, and related care coordination activities.
The Manager is responsible for ensuring effective, patient-centered care coordination across the continuum while supporting safe and timely transitions of care, appropriate utilization of healthcare resources, regulatory and payer compliance, and achievement of organizational quality, financial, and patient experience goals.
This position leads an interdisciplinary team responsible for identifying and addressing barriers to care and discharge, coordinating complex patient needs, supporting appropriate level-of-care determinations, and connecting patients and families with appropriate healthcare and community resources.
The Manager collaborates closely with physicians, nursing leadership, Quality, Revenue Cycle, Compliance, Risk Management, community providers, post-acute care organizations, and other members of the healthcare team to improve patient outcomes and facilitate efficient movement of patients through the continuum of care.

EXPECTATION FOR ALL EMPLOYEES

Support the organization's mission, vision and values by adhering to the behavioral standards of Bay Area Hospital. Comply with all laws and regulations affecting Bay Area Hospital. Be familiar with and adhere to the Bay Area Hospital Code of Conduct and Compliance Program. Effective communication skills and the ability to work effectively with people from various backgrounds are critical.

POSITION SUMMARY

The Manager of Case Management & Social Services provides operational and clinical leadership for Case Management, Social Services, discharge planning, utilization management, transitions of care, and related care coordination activities.

PRINCIPLE DUTIES AND RESPONSIBILITIES

Leadership & Staff Management

• Provides daily operational leadership and oversight for Case Management, Social Services, utilization management, discharge planning, and care coordination functions.
• Recruits, selects, develops, supervises, and evaluates department employees in accordance with hospital policies and leadership expectations.
• Establishes clear performance expectations and monitors employee performance, productivity, competency, and professional development.
• Recognizes employee strengths, provides timely coaching and feedback, and develops performance improvement plans or corrective action when appropriate.
• Promotes a collaborative, accountable, patient-centered work environment consistent with Bay Area Hospital’s Behavioral Standards.
• Identifies department education and competency needs and collaborates with Clinical & Professional Development and other resources to provide appropriate education and training.
• Serves as a subject matter resource and provides guidance to staff regarding complex cases, discharge barriers, utilization concerns, patient/family needs, and escalation processes.

Case Management, Social Services & Care Coordination

• Oversees the development, implementation, and ongoing evaluation of effective case management, social services, utilization management, discharge planning, and transitions-of-care processes.
• Ensures early identification and proactive management of barriers that may delay treatment, progression of care, discharge, or transition to the next appropriate level of care.
• Promotes interdisciplinary care planning and effective collaboration among physicians, nursing, therapy, pharmacy, behavioral health, social services, post-acute providers, patients, families, and other members of the healthcare team.
• Supports effective management of complex patient populations, including patients with significant medical, behavioral health, psychosocial, financial, housing, transportation, caregiver, or post-acute care needs.
• Ensures patients and families receive appropriate education, resources, referrals, and support necessary for safe and effective transitions of care.
• Develops and maintains collaborative relationships with skilled nursing facilities, home health agencies, hospice providers, behavioral health organizations, community agencies, payers, and other post-acute and community partners.
• Supports processes intended to reduce preventable readmissions, avoidable delays, unnecessary utilization, and gaps in transitions of care.

Utilization Management & Regulatory Compliance

• Provides oversight of utilization management activities to support appropriate patient status, medical necessity, level of care, and efficient use of hospital resources.
• Ensures Case Management and Social Services practices comply with applicable CMS Conditions of Participation, state and federal requirements, payer requirements, accreditation standards, and hospital policies.
• Supports processes for timely utilization review, patient status evaluation, required patient notices, discharge planning evaluations, and documentation.
• Collaborates with physicians, physician advisors, and other stakeholders to address utilization, authorization, medical necessity, and payer-related issues.
• Monitors regulatory and industry changes affecting case management, utilization management, discharge planning, social services, and transitions of care and incorporates changes into department practices as appropriate.
• Develops, reviews, and maintains department policies, procedures, workflows, and competencies consistent with evidence-based practices and regulatory requirements.

Quality, Patient Experience & Performance Improvement

• Establishes, monitors, and evaluates department performance measures and uses data to identify opportunities for improvement.
• Monitors key indicators such as length of stay, avoidable days, discharge delays, readmissions, utilization trends, discharge disposition, denials, and other organizationally identified measures.
• Collaborates with Quality and clinical leadership to ensure department activities support hospital-wide quality, patient safety, and performance improvement priorities.
• Leads or participates in interdisciplinary initiatives designed to improve patient flow, transitions of care, discharge efficiency, resource utilization, and patient outcomes.
• Incorporates patient and family feedback into improvement efforts and promotes communication, education, and coordination practices that support a positive patient experience.
• Uses performance data, benchmarking, trends, and root-cause analysis to identify opportunities and implement sustainable process improvements.

Financial & Operational Management

• Develops, manages, and monitors department budgets, staffing plans, productivity, and resource utilization.
• Evaluates staffing requirements based on patient volume, acuity, workload, organizational priorities, and regulatory requirements.
• Identifies opportunities to improve operational efficiency while maintaining appropriate quality, safety, and service standards.
• Collaborates with hospital leadership regarding staffing, resources, technology, and other operational needs affecting Case Management and Social Services.
• Provides reports, analysis, and recommendations to leadership regarding department performance, utilization trends, discharge barriers, and opportunities for improvement.
• Performs other duties as assigned.

SKILLS AND ABILITIES

• Demonstrated knowledge of acute-care case management, social services, discharge planning, utilization management, transitions of care, and healthcare reimbursement principles.
• Strong leadership skills with demonstrated ability to coach, develop, engage, and hold employees accountable.
• Knowledge of CMS requirements, Conditions of Participation, payer requirements, medical necessity, patient status, and regulatory standards applicable to case management and discharge planning.
• Demonstrated ability to analyze clinical and operational data, identify trends, and lead performance improvement initiatives.
• Strong critical-thinking, problem-solving, conflict-resolution, and decision-making skills.