RN Manager, Jewish Hospital, Care Management

Job description

Primary Location:
JHHS - Jewish Hospital - UMC
Address:
200 Abraham Flexner Way
Louisville, KY 40202

Shift:
Salary Shift (United States of America)
Job Description Summary:
UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehab Institute and Brown Cancer Center.
With more than 12,000 team members—physicians, surgeons, nurses, pharmacists, and other highly skilled health care professionals—UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.
Job Description:
Under the direction of the Director of Care Coordination, the Manager, Care Management performs activities which support the daily function of the Care Coordination Department. The Manager, Care Management promotes optimal patient outcomes in accordance with the policies, procedures, applicable laws and contracts, philosophy, mission, vision and values of UofL Health. The individual is the main driver of length of stay and readmission outcomes for the facility. This Manager, Care Management works to help ensure institutional compliance with regulatory agencies and third-party payers.
This person must demonstrate a working knowledge of finance, reimbursement, third party payers, community resources/agencies, accreditation standards, quality improvement, clinical care, and board base organization issues. Utilizes the management process (plan, organize, direct and control) to provide a framework for decision-making. Maintains confidentiality of information; actively supports organizational goals and objectives by providing needed information to divisions and departments. Must be able to adjust priorities quickly, organize multiple tasks simultaneously, and work interdependently with many levels of staff. Attention to detail; strong organizational, interpersonal and communication skills; and innovative problem-solving skills required. Must be able to adjust work hours depending upon departmental and organizational needs as determined by the director.
Essential Functions:
• Promotes the care management team’s optimal management of clinical resources by conducting timely initial admission assessments based on clinical indicators and anticipated service needs; readmission risk assessments, timely referrals to ancillary & post-acute services, recommendations for appropriate level of hospital care, and validation of patient demographics and payor source.
• Assists with the development of policies and procedures to ensures departmental compliance with regulatory, ethical, legal, and accreditation standards, guidelines and regulations.
• Develops monitoring and tracking systems to improve data collection for the sole purpose of improving length of stay, readmissions, and use of hospital ancillary services in order to enhance reimbursement.
• Ensures the development and documentation of the multidisciplinary clinical assessment of patients on an on-going basis by the RN Care Manger. Monitor for staff active participation in daily unit Rapid Rounds.
• Assists with the development of policies and procedures to ensures departmental compliance with regulatory, ethical, legal, and accreditation standards, guidelines and regulations.
• Monitors and maintains all PTO request in SmartSquare following the Care Coordination PTO guidelines.
• Leads the staff in a manner consistent with hospital philosophy and correct business principles.
• Enter, verify and sign off payroll in Kronos on a bi-monthly basis to ensure appropriate team member compensation.
• Evaluates technology, resources, and tools for application and use in daily operation and make recommendations which will improve our processes, systems, and revenue.
• Promotes education and involvement of staff; encourages certification.
• Demonstrates ability to motivate staff in a positive manner and to improve cohesiveness of the group.
• Participates in professional organizations; keeps abreast of changes in the field and pro-actively seeks to keep the hospital up to date.
• Represents the department in leadership activities as needed (committee work, JCAHO preparation, meetings, etc.); serves as a professional role model for others.
• Collaborates with clinical and financial staff to meet financial goals of the hospital.
• Aware of reimbursement changes, problems and patterns of reimbursement, taking action as needed to improve or resolve issues.
• Works with the director and staff to develop departmental goals to support the mission and direction of the hospital.
• Enhances professional growth and development through participation in educational programs, reading current literature, attending in-service meetings and workshops that are related to assigned areas of responsibility. Assumes responsibility of growth and development, maintains competency in care management principles.
• Committed to patient satisfaction and uses appropriate tools and services recovery to meet expected patient satisfactions metrics
• Actively involved to meet organization metrics and goals to ensure the financial security of the organization.
• Advocates for patient/family needs in a respectful, unbiased, and confidential manner.
• Educates physicians, patients and staff with regards to payors, financial issues, documentation, and potential compliance issues.
• Serves as a resource to physicians for clinical management and financial issues. Assists the providers with promoting efficiencies in the care delivery system and reducing/ eliminating barriers to efficient/effective service.
• Possess strong problem-solving skills and takes initiative to so. Works effectively with others. Knowledgeable of the services lines and uses sound nursing judgement and adheres to the code of professional conduct.
• Promotes departmental goals of improved quality, improved patient outcome and conserving resources as evidenced by value enhancement activities.

Other Functions:
• Knowledgeable of state laws, CMS conditions of participation, and TJC standards regarding regulatory requirements for care management and discharge planning and compliance with each.
• Maintain compliance with all company policies, procedures, and standards of conduct.
• Comply with HIPAA privacy and security requirements to always maintain confidentiality.
• Attend specialty service line case conferences and staff meetings.
• Maintains an active, unrestricted Kentucky Registered Nurse Licensure.
• Maintains current Basic Life Support-CPR.

Additional Job Description:
Education:
• Must have RN with a BSN. Master’s Degree in Nursing, Business, Health Care Administration or equivalent preferred.

Experience:
• Five (5) years as Care Manager/Utilization Review Nurse
• Two (2) years acute hospital experience (preferred)

Licensure:
• Unrestricted RN license in the state of Kentucky (required).

Certification:
• BLS-CPR (required)
• Case Management Certification (ACM, ANCC-Nurse Case Manager or CCM) (preferred).