Manager, Inpatient Case Management Afterhours (RN)

Position Summary:

Reporting to the Senior Director of Case Management, this position is directly responsible for managing the daily operations of inpatient case management across Regal Medical Group.  The Manager, Inpatient Case Management is responsible for oversight of inpatient review, concurrent review and discharge planning of inpatient cases for all members assigned to this region.  Responsible for the development of concurrent review and discharge planning training and quality review programs that maximize quality while utilizing appropriate resources within the members’ benefit plans and established contracts. The Manager will also be responsible for cooperation and problem solving with network management, finance, and claims department. The manager is expected to work in collaboration with other medical management departments to ensure optimal clinical outcomes, appropriate resource utilization, quality patient care, and high enrollee satisfaction.

The manager will participate in process improvement measures such as standardized documentation and auditing, programs that maximize quality, and programs to ensure appropriate resource utilization within members benefit plan and established contract.

The Manager, Inpatient Case Management is responsible, along with other members of Medical Management Team, for contributing to the clinical, quality, financial and patient satisfaction outcomes of Regal Medical Group.

Essential Duties and Responsibilities include the following:

• Manages inpatient nurse case managers and ensures optimal staff performance.
• Performs facility visits to mentor, evaluate and assist Regal Inpatient Case Managers stationed in regional hospitals.
• Identifies and implements policies and procedures that incorporate best practices and ensure effective inpatient concurrent reviews.
• Assists in overseeing compliance and consistency of the program that meets RMG and regulatory standards.
• Develop and maintains effective working relationships with hospital case management departments to optimize collaboration and facilitate timely reviews.
• Develops and implements training plans for new and existing staff.
• Acts as a resource for clinical staff for case review and discharge planning.
• Develops, monitors, and analyzes reports and identifies trends to develop programs and processes that improve program outcomes.
• Participates in developing and coordinating strategies across the continuum of care for ensuring the delivery of care in the most cost effective setting.
• Works with the Medical Directors on a daily basis to review inpatient hospitalizations with inpatient staff for level of care and discharge planning, including review of face sheets and assuming a nurse leadership role with rounds. Will assist with cases in need of complex discharge planning.
• Maintains on-call schedule and participates in on-call process as needed for training and monitoring of nurses.
• Develops annual department goals and objectives focused on improving patient outcomes and department efficiency.
• Maintains quality monitors as determined by the Utilization Management and Quality Management Committees and RMG Management.
• Responsible for orientation, instruction/training of new personnel.
• Works collaboratively with the entire Medical Management team to ensure compliance with regulatory and health plan requirements.
• Oversees “triage” of patients to the appropriate level of care and facility, and acts as a resource to other concurrent review nurses in the transfer process.
• Works closely with other departments (claims, finance, high risk, TOC) as needed.
• Anticipate our customer needs: Understand the wants and needs of customers, listen for cues and identify how to respond and what level of intervention they need.       
• Maintains high level of professionalism and cultural competency when working with members and hospital staff.
• Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
• Demonstrates honesty and integrity in everyday activities.
• Protects privacy for both patients and employees; ensures information sensitive papers, charts, and reports are not in view of the public.
• Recognizes when an error has been made and immediately reports to appropriate manager.
• Participates in “service recovery” through follow-up with an upset customer, gathering information, and demonstrates empathy.
• Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families.  Functions as liaison between administration, patients, p