Manager- Case Management Job Listing at Wilson Health in Sidney, OH (Job ID 8a7887ac8b729b48018b81227190243e)

Description

Wilson Health is seeking a full time Manager of Case Management to join our team.   Key Perks and Benefits:

• Access to Employer Direct Care Clinic.  Free medical care and pharmacy services for all benefit eligible employees.  Dependents are eligible for free medical care if they are covered by Wilson Health's medical insurance plan.
• Generous paid time off program beginning day one of employment.
• Medical Insurance: Choice of Two High Deductible Health Plan Options or a PPO, Dental and Vision Insurance- Coverage Begins Day One of Employment.
• H S A with employer contribution for eligible health plans, FSA for medical and dependent care expenses.
• Company Paid Life Insurance and Long Term Disability Insurance, Salary Continuation benefit beginning day one.
• Voluntary Accident, Critical Illness, and employee and dependent Life and AD&D Insurance.
• Industry leading retirement plan- employer contributions begin day one, no waiting period for participation.
• Tuition Assistance Program.

SUMMARY:  Oversees the staff of the Case Management Department.  Responsible for the day-to-day operations of Case Management Program including utilization review, discharge planning and inpatient denials management.  Oversees utilization reviews by the Case Managers.  Prepares and maintains reports and records related to utilization review and shares information with key stakeholders.  Facilitates and ensures the provision and achievement of quality care and appropriate utilization of resources.  Responsible for addressing and resolving variances in care/services that could potentially result in negative quality/cost impact.   ESSENTIAL DUTIES AND RESPONSIBILITIES:  The patient population would include:

• When necessary, performs review functions for appropriateness of admission, continued hospital stay, clinical documentation, and best practice standards reporting.
• Conducts the analysis of treatment plans and alternatives, makes recommendations for the most appropriate plan, and coordinates the activities of professional staff, agencies, suppliers and family members in achieving planned outcomes as necessary.
• Performs case audits to verify consistency and effectiveness of compliance with standards of care, documentation, and provision of services.
• Provides clarification and interpretation of Case Management Program guidelines, standards, goals, and expectations.
• Collaborates with other disciplines, oversees the development, implementation, monitoring and modification of the plan of care for the patient through a collaborative and interdisciplinary team approach assigned multidisciplinary care conference and outpatient opportunities for care.
• Conducts multi-disciplinary rounds daily Monday-Friday.
• Functions as a resource for physicians, nursing, and ancillary staff regarding continuum of care to support estimated length of stay, avoidable hospital days, quality measures and discharge planning needs.
• Facilitates education of Case Management staff related to the assessment of the patient's physical, psychological, functional, social, environmental, and financial status and goals.
• Assists in data gathering and analysis and makes recommendations for program process improvements. 
• Participates and supports CQI projects throughout the institution. 
• Facilitates appropriate physician documentation to support best practice standards, severity of illness, risk of mortality, and complexity of care for the patient.
• Facilitates case referrals to the Utilization Review Physician Advisor as appropriate.
• Serves as a member of the Utilization Review Committee and provides data related to patterns and trends of utilization and resource management.
• Coordinates management of all inpatient medical necessity denials and appeals and works closely with Revenue Cycle Team to operationalize improvements to reduce denials.
• May manage an individual caseload of patients, to be determined as needed.
• Demonstrates responsibility for own professional growth.
• Performs additional duties as assigned within the scope of responsibility.

  EDUCATION and/or EXPERIENCE:  Graduate of an accredited school of nursing.  Bachelor of Science degree preferred.  Minimum of three (3) years management experience.   CERTIFICATES, LICENSES, REGISTRATIONS: 

• Currently holds an active, unrestricted license to work as a Registered Nurse in the State of Ohio.
• Certification in Case Management from ACMA or CMSA preferred.
• Must have a strong knowledge of utilization review

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