Nurse Manager Case Management

Overview

• Lead and manage the Care Management team, ensuring effective coordination and delivery of patient care services.
• Collaborate with multidisciplinary teams to optimize patient transitions and discharge planning processes.
• Oversee compliance with healthcare standards and policies, ensuring quality and safety in care management practices.
• Develop and implement training programs to enhance staff skills and knowledge in care management.
• Monitor and report on key performance metrics, including quality, outcomes, and productivity.
• Coordinate with post-acute providers to ensure seamless patient transitions and continuity of care.
• Support the Population Health Program by aligning care management strategies with community health goals.
• Provide leadership and guidance to staff, fostering teamwork and professional growth.

Key Responsibilities & Duties

• Supervise and direct the Care Management team, including RNs, coordinators, and educators.
• Ensure compliance with discharge planning policies and post-acute care provider agreements.
• Manage payroll, scheduling, and staffing needs to meet patient care demands.
• Collaborate with clinical informatics to improve care management documentation and processes.
• Identify opportunities to enhance post-discharge services and reduce readmissions.
• Participate in committees and multidisciplinary conferences to support care management initiatives.
• Develop and oversee training programs for staff and providers on care management services.
• Evaluate and address customer concerns to ensure satisfaction with care management services.

Job Requirements

• Bachelor’s degree in nursing or Master’s degree in social work with LCSW required.
• Minimum of 5 years of acute care hospital or health plan experience for RN candidates.
• 7 years of experience required for LCSW candidates in relevant settings.
• Prior supervisory or management experience in a clinical role is essential.
• RN license or LCSW certification is mandatory, with CCM or ACM certification within 2 years of hire.
• Basic Life Support (BLS) certification and annual workplace violence prevention training required.
• Knowledge of health care provider organizations, health plans, and medical management functions.
• Experience with Medicaid/Medi-Cal patients and government programs preferred.