Care Coordination/Utilization Mgmt Manager
- Full-Time
- Arlington Heights, IL
- Northwest Community Healthcare
- Posted 3 years ago – Accepting applications
Job Description
Shift: Full time, Days
Reporting to the Director of Clinical Care Coordination with dotted line to the Director of Revenue Cycle, oversees the daily operations of Clinical Care Coordinators-Unit, Critical Care, Emergency and Surgical (C3) and Utilization Managers (UM) to ensure optimal performance in all areas of service, in compliance with hospital policies and regulatory standards. Establishes implements and maintains measures for appropriate staffing, productivity, compliance, quality, accuracy and customer service. Responsible for managing staff, staff development and maintenance of standards of practice in accordance with the evolving practices of the Clinical Care Coordinators and Utilization Management team. Assures that the nursing process is utilized as the framework for patient care and applies the nursing process to their own practice as defined in the American Nurses Associations (ANA) Scope and Standards for Nurse Administrators. This job description was developed in accordance with the Illinois Nurse Practice Act and the ANA Scope and Standards of Practice.
1. Manages the daily operations of the Clinical Care Coordination/Utilization Management team. Plans, schedules and adjusts staffing levels to meet department and hospital requirements. Develops, secures approvals and implements policies while providing staff with interpretation and guidance to ensure consistent quality service.
2. Conducts unit rounds to observe and coach C3’s and UM’s regarding performance, updates patient status and monitors compliance with standards and regulatory requirements. Observes and assists staff to oversee workflow, resolve operational issues and monitor productivity to ensure delivery of quality services to meet the needs of patients, families, physicians and staff.
3. Ensures the ongoing use of the ‘Status-Now-Action-Planning” (SNAP) huddles and multidisciplinary meetings to examine patient flow and outcome management including disease management and consistency of departmental training and annual competencies. Reviews staff documentation, both in the medical record and within the various software programs utilized in Clinical Care Coordination and Utilization Management to ensure compliance and accuracy. Utilizes open chart reviews and status reviews to monitor performance measures and make adjustments to operations as needed.
4. Organizes and conducts staff meetings to communicate departmental performance data, discuss identified problems, system related issues, outcomes, standards of practice, and/or other related practice issues. Identifies and resolves issues, challenges or roadblocks impacting the department. Demonstrates accountability for outcomes through critical thinking and effective problem resolution.
5. Provides clinical, disease management and utilization management expertise, consultation and support services as needed. Provides counseling, intervention and guidance in complex situations as needed to assist in resolving problems with patients, families, physicians or staff. Develops and maintains collaborative working relationships among UM’s, C3’s, Social Workers, Medical Staff, nursing and other departments and staff.
6. Develops and prepares reports and analyses of departmental processes, service, productivity standards, Continuous Quality Improvement (CQI), budgetary performance and adherence to compliance standards. Performs inter-rater reliability and other performance and quality related audits. Reviews findings, provides rationale for conclusions and recommends improvements to operational protocols with Director(s).
7. Attends and prepares required documentation for all Revenue Cycle meetings including RCM weekly update and monthly Revenue Cycle Subcommittee meetings.
8. With Physician Advisor, co-leads Utilization Management Committee meetings.
9. In consultation with Director(s), assists in the development of short and long-term goals and initiatives, ensuring compatibility with the overall department and hospital objectives. Participates in the development of the annual business plan and budgeting process. Manages operational performances in accordance with the budget and established goals by initiating staffing changes, or by making other operational adjustments to maintain budgeted parameters.
10. Oversees the educational needs of the department, including orientation for new team members and on-going educational programs i.e. regulations, technology, customer service skills, policies and procedures, etc. for all staff. Participates in the design and development of formal orientation and training programs for existing staff and new hires. Documents and integrates ongoing training and staff development changes into existing patient care, safety, infection control and regulatory compliance requirements. Utilizes competency checklists for documentation and consistency of departmental training and annual competencies.
11. Interviews, hires, disciplines and discharges (when necessary) subordinate team members in accordance with Northwest Community Hospital (NCH) policies and procedures. Regularly evaluates the on-going performance of team members in accordance with the hospital’s performance management system. Supports development of team member’s knowledge and skills through regular feedback and review of practice, documentation, recognition of positive accomplishments, didactic training and coaching opportunities. Ensures staff compliance with maintaining, reporting and updating changes to contract information, professional credentials, certifications and licensure.
12. Adheres to all Northwest Community Hospital standards, policies, and procedures.
Qualifications1. Bachelor’s Degree in Nursing required. Master’s degree preferred.
2. Registered Nurse with current licensure to practice nursing in the State of Illinois required.
3. Minimum of five years of case management experience in a hospital setting required.
4. Certified Case Manager (CCM) or Accredited Case Manager (ACM) credential preferred.
5. Previous experience in hospital Leadership or Management role preferred; hospital case management leadership experience preferred.
6. Knowledge of clinical case management including disease management, discharge planning, health care reimbursement, and utilization review process and applicable community resources with the clinical expertise to act as a resource to assigned units.
7. Knowledge of Diagnosis Related Groups (DRGs) and other reimbursement models for their impact on assessment of level of care/use of resources including current knowledge of Medicare, Medicaid and other third party payer reimbursement methodologies.
8. Knowledge of managed care models, financial reimbursement systems, clinical case management processes and utilization management issues.
9. Knowledge of federal, state and other regulatory agency rules & regulations including Illinois Department of Public Health, The Joint Commission, Center for Medicare and Medicaid Services, etc.
PHYSICAL REQUIREMENTS:
1. Requires light physical effort. May require long periods of sitting, computer use, standing or walking. May require frequent lifting or moving of lightweight materials, rarely moving or lifting of heavy materials.
2. Flow of work and character of duties involve part normal and part concentrated attention.
WORKING CONDITIONS:
1. Conditions are acceptable. At least one disagreeable element or hazard is occasionally present in the environment, i.e., infectious diseases. Probability of injury is unlikely.
About Us
Serving Chicago's northwest suburbs since 1959, we are an independent, not-for-profit healthcare system dedicated to providing outstanding care in the communities we call home. Our comprehensive, patient-centered system of care has dozens of locations throughout the area.
Our award-winning care has been recognized on a national level. Some of our top awards include:
Annually, we treat an average of 20,000 inpatients and provide:
Over the years, we have continued to grow to meet the area's changing needs. Today, we're a world-class healthcare provider that combines compassionate care with a healing environment, cutting-edge clinical expertise and state-of-the-art facilities, including:
Apply to this Job
Reporting to the Director of Clinical Care Coordination with dotted line to the Director of Revenue Cycle, oversees the daily operations of Clinical Care Coordinators-Unit, Critical Care, Emergency and Surgical (C3) and Utilization Managers (UM) to ensure optimal performance in all areas of service, in compliance with hospital policies and regulatory standards. Establishes implements and maintains measures for appropriate staffing, productivity, compliance, quality, accuracy and customer service. Responsible for managing staff, staff development and maintenance of standards of practice in accordance with the evolving practices of the Clinical Care Coordinators and Utilization Management team. Assures that the nursing process is utilized as the framework for patient care and applies the nursing process to their own practice as defined in the American Nurses Associations (ANA) Scope and Standards for Nurse Administrators. This job description was developed in accordance with the Illinois Nurse Practice Act and the ANA Scope and Standards of Practice.
1. Manages the daily operations of the Clinical Care Coordination/Utilization Management team. Plans, schedules and adjusts staffing levels to meet department and hospital requirements. Develops, secures approvals and implements policies while providing staff with interpretation and guidance to ensure consistent quality service.
2. Conducts unit rounds to observe and coach C3’s and UM’s regarding performance, updates patient status and monitors compliance with standards and regulatory requirements. Observes and assists staff to oversee workflow, resolve operational issues and monitor productivity to ensure delivery of quality services to meet the needs of patients, families, physicians and staff.
3. Ensures the ongoing use of the ‘Status-Now-Action-Planning” (SNAP) huddles and multidisciplinary meetings to examine patient flow and outcome management including disease management and consistency of departmental training and annual competencies. Reviews staff documentation, both in the medical record and within the various software programs utilized in Clinical Care Coordination and Utilization Management to ensure compliance and accuracy. Utilizes open chart reviews and status reviews to monitor performance measures and make adjustments to operations as needed.
4. Organizes and conducts staff meetings to communicate departmental performance data, discuss identified problems, system related issues, outcomes, standards of practice, and/or other related practice issues. Identifies and resolves issues, challenges or roadblocks impacting the department. Demonstrates accountability for outcomes through critical thinking and effective problem resolution.
5. Provides clinical, disease management and utilization management expertise, consultation and support services as needed. Provides counseling, intervention and guidance in complex situations as needed to assist in resolving problems with patients, families, physicians or staff. Develops and maintains collaborative working relationships among UM’s, C3’s, Social Workers, Medical Staff, nursing and other departments and staff.
6. Develops and prepares reports and analyses of departmental processes, service, productivity standards, Continuous Quality Improvement (CQI), budgetary performance and adherence to compliance standards. Performs inter-rater reliability and other performance and quality related audits. Reviews findings, provides rationale for conclusions and recommends improvements to operational protocols with Director(s).
7. Attends and prepares required documentation for all Revenue Cycle meetings including RCM weekly update and monthly Revenue Cycle Subcommittee meetings.
8. With Physician Advisor, co-leads Utilization Management Committee meetings.
9. In consultation with Director(s), assists in the development of short and long-term goals and initiatives, ensuring compatibility with the overall department and hospital objectives. Participates in the development of the annual business plan and budgeting process. Manages operational performances in accordance with the budget and established goals by initiating staffing changes, or by making other operational adjustments to maintain budgeted parameters.
10. Oversees the educational needs of the department, including orientation for new team members and on-going educational programs i.e. regulations, technology, customer service skills, policies and procedures, etc. for all staff. Participates in the design and development of formal orientation and training programs for existing staff and new hires. Documents and integrates ongoing training and staff development changes into existing patient care, safety, infection control and regulatory compliance requirements. Utilizes competency checklists for documentation and consistency of departmental training and annual competencies.
11. Interviews, hires, disciplines and discharges (when necessary) subordinate team members in accordance with Northwest Community Hospital (NCH) policies and procedures. Regularly evaluates the on-going performance of team members in accordance with the hospital’s performance management system. Supports development of team member’s knowledge and skills through regular feedback and review of practice, documentation, recognition of positive accomplishments, didactic training and coaching opportunities. Ensures staff compliance with maintaining, reporting and updating changes to contract information, professional credentials, certifications and licensure.
12. Adheres to all Northwest Community Hospital standards, policies, and procedures.
Qualifications1. Bachelor’s Degree in Nursing required. Master’s degree preferred.
2. Registered Nurse with current licensure to practice nursing in the State of Illinois required.
3. Minimum of five years of case management experience in a hospital setting required.
4. Certified Case Manager (CCM) or Accredited Case Manager (ACM) credential preferred.
5. Previous experience in hospital Leadership or Management role preferred; hospital case management leadership experience preferred.
6. Knowledge of clinical case management including disease management, discharge planning, health care reimbursement, and utilization review process and applicable community resources with the clinical expertise to act as a resource to assigned units.
7. Knowledge of Diagnosis Related Groups (DRGs) and other reimbursement models for their impact on assessment of level of care/use of resources including current knowledge of Medicare, Medicaid and other third party payer reimbursement methodologies.
8. Knowledge of managed care models, financial reimbursement systems, clinical case management processes and utilization management issues.
9. Knowledge of federal, state and other regulatory agency rules & regulations including Illinois Department of Public Health, The Joint Commission, Center for Medicare and Medicaid Services, etc.
PHYSICAL REQUIREMENTS:
1. Requires light physical effort. May require long periods of sitting, computer use, standing or walking. May require frequent lifting or moving of lightweight materials, rarely moving or lifting of heavy materials.
2. Flow of work and character of duties involve part normal and part concentrated attention.
WORKING CONDITIONS:
1. Conditions are acceptable. At least one disagreeable element or hazard is occasionally present in the environment, i.e., infectious diseases. Probability of injury is unlikely.
About Us
Serving Chicago's northwest suburbs since 1959, we are an independent, not-for-profit healthcare system dedicated to providing outstanding care in the communities we call home. Our comprehensive, patient-centered system of care has dozens of locations throughout the area.
Our award-winning care has been recognized on a national level. Some of our top awards include:
- America's 250 Best Hospitals™ Award recipient for three years in a row from Healthgrades®
- Magnet® designation for nursing excellence, received consecutively since 2006
- The Joint Commission's Gold Seal of Approval and Comprehensive Stroke Center designation
- 4,000 employees
- 1,200 physicians on staff
- 200 primary are and specialty physicians
Annually, we treat an average of 20,000 inpatients and provide:
- 350,000 outpatient visits
- 76,000 emergency department visits
- 38,000 home care visits
- 2,700 newborn deliveries
Over the years, we have continued to grow to meet the area's changing needs. Today, we're a world-class healthcare provider that combines compassionate care with a healing environment, cutting-edge clinical expertise and state-of-the-art facilities, including:
- A 509-bed hospital, including the South Pavilion with 200 private rooms
- The William J. and Marian H. Busse Center for Specialty Medicine, an eight-floor facility housing physician offices, medical specialty services and advanced diagnostic technology
- A Level III NICU, Level II Trauma Center and a dedicated pediatric emergency department
- Five Immediate Care Centers, in Buffalo Grove, Kildeer, Mount Prospect, Palatine and Schaumburg
- 23 physician offices in Arlington Heights, Buffalo Grove, Kildeer, Mount Prospect, Palatine, Rolling Meadows and Schaumburg
- Nine outpatient imaging locations that provide advanc emergency department
- Five Immediate Care Centers, in Buffalo Grove, Kildeer, Mount Prospect, Palatine and Schaumburg
- 23 physician offices in Arlington Heights, Buffalo Grove, Kildeer, Mount Prospect, Palatine, Rolling Meadows and Schaumburg
- Nine outpatient imaging locations that provide advanced imaging technology, including MRI, CT, ultrasound, X-ray and 3D mammography
- 13 clinical laboratory sites in seven suburbs and at the hospital
- 33-bed acute inpatient rehabilitation unit and seven outpatient rehabilitation centers
- The Wellness Center, a premier health and fitness center and spa on the NCH campus
- A full-service, retail pharmacy on the hospital campus
Primary Location: United States-Illinois-Arlington Heights
Work Locations: 800 W Central - Hospital 800 W Central Rd Arlington Heights 60005
Job: Management
Shift: Day Job
Employee Status: Regular