Manager - RN - Case Management - FT - Days - MRH

Memorial Healthcare

1d•Onsite

About The Position

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Assumes 24-hour accountability for managing the functions of Access, Care Coordination, and Discharge Planning. With the Manager - Social Work, serves as the central resource to the Director - Case Management to develop strategies which are efficient, effective, timely, patient-centered, and support appropriate financial reimbursement. To meet accountabilities of the Care Management Dashboard, collaborates with all disciplines, departments, payers, system partners, vendors, and community agencies to optimize clinical outcomes within best practice, ethical, legal, and regulatory parameters.

Requirements

Accredited Program: Nursing (Required)
Registered Nurse Compact License (RN LICENSE COMPACT) - Compact RN Multistate, Registered Nurse License (RN LICENSE) - State of Florida (FL)
Complexity of Work: Responsible for day-to-day oversight and coordination of case management and discharge planning functions ensuring patient care meets quality and efficiency standards while aligning with regulatory requirements. This role requires an understanding of payer guidelines and working closely with multi-disciplinary teams to optimize patient flow. Requires critical thinking and effective communication (verbal and written) skills, decisive judgment, and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Knowledge of State and Federal regulations governing discharge planning conditions of participation, hospital information systems (e.g., logician and IDX), staff development techniques, and performance improvements processes. Strong background in clinical decision making, medical criteria, and discharge planning. Must be proficient with Interqual or Milliman guidelines and use. Proficient in process improvement, and performance monitoring.
Minimum of three (3) years of case management experience and, at least, two (2) years of leadership experience within case management.
Graduate of an accredited Registered/Professional Nursing program or a Bachelor’s degree in Nursing (BSN).

Nice To Haves

Certification in Case Management preferred.

Responsibilities

Assists with the preparation and evaluation of departmental budgets, and ensures that the department operates in compliance with allocated funding.
Coordinates and directs internal/external audits.
May collect and assess data to identify quality trends or actual sources of risk to patients and employees.
Collaborates with multi-disciplinary teams and committees with respect to quality outcomes.
Assists with the development and implementation of Case Management goals, plans, and standards consistent with the clinical, administrative, regulatory, legal, and ethical requirements.
Assists with the management and evaluation of department operations, including information technologies, service level determination and complaint management, to achieve performance and quality control objectives.
Participates in clinical performance improvement activities, including the development of clinical paths, patient/family education programs, collaborative practice groups, Six Sigma, and other quality initiatives.
Manages and constantly evaluates staffing levels, assignments, skills, learning needs, and deployment of staff.
Monitors staffing activities, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
Completes annual and interim performance reviews for all staff and contributes to performance reviews of other professionals and support staff as requested.