Case Management Manager Acute Care

Overview

• Manage case management, social work, utilization management, and discharge planning functions within an acute care setting.
• Provide leadership and oversight for clinical care teams addressing patients' psychosocial and financial needs.
• Ensure regulatory compliance, staff productivity, and continuous quality improvement initiatives.
• Collaborate with internal and external stakeholders, including patients, families, and healthcare providers.
• Promote teamwork and effective functioning within multidisciplinary teams.
• Utilize knowledge of laws, regulations, and professional standards affecting case management practices.
• Implement innovative case management programs to enhance patient care outcomes.
• Develop and monitor workflows, program goals, and staff training initiatives.
• Represent the organization to health plans, third-party payors, and other external entities.

Key Responsibilities & Duties

• Lead and manage case management and social work teams to meet organizational objectives.
• Supervise staff performance, productivity, and adherence to quality standards.
• Ensure compliance with CMS, Title 22, CHA Consent Manual, and other regulations.
• Develop and implement continuous quality improvement processes and techniques.
• Facilitate effective communication and collaboration among healthcare professionals.
• Monitor and evaluate program outcomes and patient care effectiveness.
• Provide training and development opportunities for team members.
• Utilize Meditech and Inter-Qual Criteria for case management activities.
• Address complex medical, emotional, and social needs of patients through clinical assessments.

Job Requirements

• Bachelor’s degree in Nursing required; Master’s degree preferred.
• Current California RN License and BLS Provider Care certification.
• National certification from ANCC, ACMA, or Case Management Association preferred.
• Minimum of 3 years of leadership experience in acute case management.
• Comprehensive knowledge of laws, regulations, and standards affecting case management practices.
• Proficiency in Meditech, Inter-Qual Criteria, and managed care software programs.
• Strong problem resolution abilities and customer relation skills.
• Experience in utilization management and discharge planning.
• Effective human relations and interpersonal skills to lead diverse teams.