Manager, Care Management

Manager, Care Management

CHRISTUS

Health - 3.7 Longview, TX Job Details Full-time 8 hours ago Benefits Relocation assistance Health insurance Dental insurance Flexible spending account Tuition reimbursement Paid time off Vision insurance Employee discount Flexible schedule Life insurance Qualifications Collaborate with healthcare professionals Guest relations RN License Customer service Schedule management Clinical staff training Team management Case management Centers for Medicare and Medicaid Services (CMS) Patient care Human resources Mentoring Discharge planning Healthcare team management Care coordination Associate's degree Hospital regulatory compliance Medical claim denial management Hospital experience Nursing Staff development Performance evaluation Full Job Description Come join us at

CHRISTUS

Good Shepherd Medical Center Longview! We are hiring a Manager of the Care Management Department. Why join us? Relocation Assistance Paid Time Off Hours ! Discounted childcare/daycare services. Employee discounts on flights, electronics, event tickets & more. Mental, physical, social & financial wellbeing support. Comprehensive medical, dental & vision benefit offerings.

Matched Savings Plan Requirements:

Performs and/or is able to perform all the functional responsibilities of the Care Management team. Supervises the human resource functions for the selection, orientation, continued follow-up, support and performance appraisals of staff to ensure that all related actions are managed in accordance with established hospital and departmental policies. Monitors outcomes of associates on monthly basis by report card and meetings. Assist in the development and implementation of a systematic approach to monitor the effectiveness of the Care Management Program including resolution strategies. Maintain current policies and procedure. Provides education on P&P to associates. Coordinates the delivery of patient care within Care Management purview and ensures compliance with established hospital and regulating standards. Facilitates discharge planning processed in conjunction with other disciplines.

Monitor Payer Initiatives:

Provides information to the medical and hospital staff regarding current reimbursement, review regulations and guidelines, and processing of denials. Maintains a working relationship with community agencies and external reviewing and paying agencies including the professional review organization (PRO), Medicaid, CMS, private review organizations and third party payers. Monitor compliance of Avoidable Days of the CM associates and prepare report. Issue any letters needed to be given to physicians, departments, etc. Monitor compliance of Readmits of the CM associates and prepare report. Notify Quality Management of any issues dealing with readmits. Monitor schedules, PTO, and Time and Attendance policy to Associates in the Care Management Department. Monitor Care Management Associate education requirements and compliance for the Hospital's annual requirement through Healthstream. Management of Denial Process; collaborate with Care Management Team to decrease the number of denials. Provide education and mentoring to team on denial issues. Will report to the denial meeting and perform any duties that may overturn denials. Bring knowledge to the denial meeting base on clinical experience. Guest Relations/Communications; Demonstrates positive role modeling of customer relations (customer include patient, physicians, other health care team members, and payers, etc.) Use AIDET and KWKT appropriately. Translates strategies into action steps; clearly assigns responsibility for decisions and tasks; sets clear objectives; monitors progress and achieves results. Demonstrates the confidence, drive and ability to face and overcome challenges and obstacles to achieve organizational goals. Appropriately adapts assigned assessment, treatment, and/or service methods to accommodate the unique physical, psychosocial, cultural, age-specific and other developmental needs of each patient served. Performs other duties as assigned.

Job Type:

Full-time Benefits:

Dental insurance Flexible schedule Flexible spending account Health insurance Life insurance Paid time off Relocation assistance Tuition reimbursement

Education:

Associate (Required)

Experience:

Nursing:

5 years (Preferred)

Hospital Case Management:

3 years (Required)

License/Certification:

Texas RN license (Required)

Work Location:

In person