Assistant Nurse Manager, Case Management

The Assistant Nurse Manager of Case Management uses evidence-based skills to support the delivery of effective and efficient patient care.  Case Manager Nurses address patient needs from both a physiological and economic perspective while retaining overall accountability for both.  The Assistant Nurse Manager of Case Management  is a hands-on role which oversees both Utilization Management and Transitional Care Management for Patients currently receiving care at our Hospital. In this role the Assistant Nurse Manager will partner with members of the health care team including Social Workers to assess patients and implement an appropriate plan of care. Additionally, this role is responsible for the successful interpretation of nationally recognized criteria sets to support medical necessity for both admissions, and continued stay. Finally, along with the patient, family, and health care team, this role ensures that  a safe and effective discharge plan has been created.  

 

Essential Duties and Responsibilities:

 

Directly manages the day to day operations in the case management department.

Provides direct management to the department staff, manages scheduling, and oversees the orientation of new hires. 

Evaluates and optimizes patient satisfaction with discharge planning functions.  Attempts to resolve conflicts related to discharge planning with staff, patients/families, external agencies and payers.

Assist the physician advisors in writing appeal letters to Insurance Companies

Works with the Revenue Cycle team to minimize Insurance denials.

Works with Insurance companies and the Physician Advisor to establish and communicate inpatient care severity of illness and intensity of service.

Provides support and guidance over utilization management including assisting the Physicians/Surgeons, APRN’s, and PA’s with level of care determinations. 

Maintains department metrics and audits. Provide updates to their corresponding committee or administrator.

 

Education/Experience Requirements

 

Minimum of 3 years of Case Management, discharge planning and/or utilization review experience.

Licensed as a Registered Nurse in the State of Connecticut.

BSN or working toward BSN.

Case Management Certification strongly preferred.

 

Skills/Knowledge

 

Strong interpersonal, communication, and negotiation skills.

Ability to form positive, collaborative relationships with hospital staff, patients and families.

Ability to effectively negotiate with internal and external providers of patient care services

Analytical abilities to assist in obtaining solutions to problems

Able to work independently and prioritize work.

Has familiarity with nationally recognized criteria sets including Interqual and Milliman MCG.

Able to manage multiple priorities.

Basic knowledge of computers and clinical applications.

Ability to problem solve in a proactive, creative manner using sound judgment based on factual information and clinical knowledge.

Communicate in a clear, concise, and logical manner in both oral and written presentations

 

The preferred candidate:

 

Has 5-7 years of Case Management / Utilization Management with progressively responsible experience

Exposure to Social Work, Clinical Documentation and Utilization Review in addition to hands on Case Management experience.

Has implemented processes and work on process improvements with demonstrable results

Is metrics focused and a champion of process improvement

Is a strong coach and mentor with good listening skills

Is able to establish credibility and gain the respect of his/her team as well as senior management

Is a decision maker that can deliver a roadmap and hold his/her team accountable

Empowers his/her team to solve problems and come up with solutions

Partners with operations for creative problem solving and goal setting

Has strong organizational skills

Strong familiarity with acute care case management regulations.

 

Educational / Minimum Requirements:

BSN degree (or active work toward BSN) required. Master’s degree is preferred.

 

State/Federal Mandated

RN Licensure Required

 

Bristol Hospital Mandated Educational Requirements:

General orientation at time of hire. Fire/Safety/Infection control annually. Other programs as required by The Hospital, JCAHO, DPH, OSHA, and other credentialing organizations.

 

Work Environment:  

Office and Hospital setting.  This is not a remote role.  

 

Disclaimer

The above statements are intended to describe the general nature and level of work being