Supervisor - Case Management

Schedule

Varied hours

Day Shift

Some weekends required

Full Time (80 Hours Biweekly)

General Summary

Supervises and oversees the operations of the Case Management (CM) Nurses and/or Case Management Outcomes Coordinators (CMOCs) and/or social workers/social service specialists at the assigned hospital and works in a team leadership model to develop and maintain departmental operations that are consistent with Hospital, System and community requirements/needs. Provides oversight of the CM team, ensuring the most efficient use of resources to support the provision of appropriate, cost effective and quality health care. Assists the Manager-Case Management in the provision of leadership and integration of utilization management principles throughout the Hospital.

Duties and Responsibilities

Essential Functions:

• Informs the Manager-Case Management of any payer issues regarding contracts (non-adherence or changes), performance (on-site liaisons and telephonic liaison staff) and the function of precert, concurrent review and denial management.
• Acts as a resource to CM team with questions related to their role. When needed, conducts initial reviews to ensure medial appropriateness of setting, concurrent review to ensure medical necessity for continued stay in hospital and initiates problem-solving techniques as needed to prevent over/under utilization.
• Conducts chart reviews and analysis of UR and compliance reports. Assists the with denial management tasks as directed. Shares pertinent data with the CM staff and Hospital Leadership as instructed.
• Participates with the CM leadership team in developing and maintaining CM policy including, Utilization Review, Social Services and Clinical Case Management.
• Identifies conditions that require case management across the continuum. Collaborates with the members of the patient care team to identify interdisciplinary needs.
• Advises the Manager-Case Management of known or suspected problems of under-, over-, or inappropriate utilization of resources. Assists with bringing information to the attention of the appropriate Hospital administrative staff.
• Oversees the implementation and daily operations of the lean daily management system
• Assesses and ensures staff engagement through leadership rounding and employee engagement survey results

Common Expectations:

• Assists the Manager-Case Management with CM staffing and assignments, performance evaluations and evaluation and testing of competencies (as applicable). Provides orientation, training and continuing education of staff and initiates or makes recommendations for personnel actions.
• Assists in developing budget as needed. Provides input to the Manager-Case Management on budget needs related to CM role. Aware of fund allocation within budget(s) to accomplish objectives.
• Continuously assesses and improves CM role performance through strong leadership of the team. Maintains appropriate quality control/assessment programs (if applicable).
• Prepares and maintains appropriate documentation as required.
• Maintains established policies and procedures, objectives, quality assessment and safety standards.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
• Prepares and presents utilization data analysis as required.
• Develops and initiates educational programs regarding utilization management principles and CM when needed.

Required for All Jobs:

• Performs other related duties as identified.
• WellSpan Health has adopted and implemented a compliance program to support WellSpan's values and standards for professionalism, integrity, and ethics. Expected to support and meet the values and standards of the organization and the performance expectations of the job, the department, and the compliance program.
• WellSpan Health has adopted and implemented a privacy program to safeguard the patient information and the business and operational information of the organization. Expected to support and meet the values and standards of the organization to safeguard patient and business/operational information.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Physical Demands:

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Frequently
• Reaching - Rarely
• Talking - Frequently
• Hearing - Frequently
• Repetitive Motions - Occasionally
• Eye/Hand/Foot Coordination - Occasionally

Working Environment:

• Occupational Hazards - Occasionally

Qualifications

Minimum Education:

• Bachelors Degree Nursing (BSN) Required

Work Experience:

• 2 years Experience in Case Management, Utilization Management, or clinical nursing specialty. Required
• Supervisory experience. Preferred

Licenses:

• Licensed Registered Nurse Upon Hire Required or
• Registered Nurse Multi State License Upon Hire Required and
• Basic Life Support Upon Hire Required