A Clinical Supervisor or Manager supervises staff and manages services in a clinical program. May provide clinical supervision for nursing, counseling or home health care staff. Works to ensure quality patient care. Trains and develops clinical staff and manages clinical program budgets.
Clinical Operations Manager Job Summary The Hospital Case Manager is responsible for coordinating patient care throughout the hospital stay and ensuring a safe, timely, and cost-effective transition of care. This role works closely with physicians, nurses, social workers, insurance companies, patients, and families to develop individualized care plans, facilitate discharge planning, obtain insurance authorizations, and reduce avoidable readmissions while maintaining regulatory compliance. Key ResponsibilitiesPatient Care Coordination Assess patients' medical, psychosocial, and discharge needs. Develop individualized case management plans. Coordinate multidisciplinary care with physicians, nursing staff, therapists, and ancillary departments. Monitor patient progress and adjust care plans as needed. Discharge Planning Begin discharge planning upon admission. Coordinate home health services, skilled nursing facilities, rehabilitation, hospice, or other post-acute services. Ensure patients and families understand discharge instructions. Arrange transportation and follow-up appointments. Utilization Management Review medical necessity for admissions and continued hospital stay. Monitor length of stay. Ensure compliance with payer guidelines. Collaborate with insurance companies regarding authorizations and continued stay reviews. Insurance & Authorization Obtain prior authorizations when required. Communicate with Medicare, Medicaid, commercial insurance plans, and managed care organizations. Resolve insurance-related barriers affecting patient care. Patient & Family Education Educate patients regarding treatment plans and available community resources. Provide disease management education. Discuss financial assistance resources when appropriate. Documentation Maintain accurate and timely documentation in the Electronic Medical Record (EMR). Complete utilization review documentation. Document discharge planning activities and care coordination notes. Ensure compliance with CMS, Joint Commission, and hospital policies. Collaboration Participate in interdisciplinary rounds. Work closely with physicians, nursing, pharmacy, rehabilitation, social services, and financial counselors. Coordinate communication between hospital departments and external providers. Quality Improvement Monitor readmission risks. Assist with quality improvement initiatives. Participate in case reviews and performance improvement projects. Support hospital accreditation standards. Required QualificationsEducation Bachelor's degree in Nursing (BSN), Social Work (BSW/MSW), or related healthcare field. RN license or Licensed Clinical Social Worker (LCSW) preferred. Experience 2-5 years of hospital clinical experience. Previous case management or utilization review experience preferred. Experience with Medicare Advantage and managed care preferred. Required Skills Strong clinical assessment skills Critical thinking and problem-solving Knowledge of CMS regulations Discharge planning expertise Care coordination Utilization review Insurance authorization management Excellent communication skills Time management Conflict resolution Patient advocacy EMR documentation Multidisciplinary teamwork Knowledge of community resources Preferred Certifications Certified Case Manager (CCM) Accredited Case Manager (ACM) Certified Professional in Healthcare Quality (CPHQ) (preferred) Key Performance Indicators (KPIs) Average Length of Stay (LOS) Readmission Rate (30-day) Discharge Before Noon Percentage Timely Completion of Discharge Plans Insurance Authorization Turnaround Time Patient Satisfaction Scores Avoidable Days Reduction Denial Rate Documentation Compliance Care Plan Completion Rate Physical Requirements Ability to sit, stand, and walk for extended periods. Ability to communicate effectively with patients and healthcare professionals. Ability to use computers and electronic medical records. Occasionally lift up to 25 pounds. Work Environment Acute Care Hospital Inpatient Units Emergency Department Intensive Care Units Medical-Surgical Units Case Management Office Core Competencies Patient Advocacy Compassion Clinical Judgment Communication Collaboration Accountability Ethical Decision-Making Leadership Organization Adaptability Cultural Competence Confidentiality (HIPAA Compliance)
Pay:
$23.10 - $27.81 per hour
Benefits:
401(k) 401(k) matching Dental insurance Health insurance Life insurance Paid time off Vision insurance
