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Lead Care Manager, UR Case Management, St Francis Hospital, Evanston


Requisition ID: 54111

Location: Presence St Francis Hosp

Location Address:
355 Ridge Avenue, Evanston, IL 60202 United States (US)

Daily Hours: 8
Standard Hours: 40
Employment Status: Full-time
Employment Type: Regular
Shift: Day
FLSA: E

SUMMARY

The Lead Case Manager serves as the lead for the care management team in the absence of the Regional Lead. Performs lead duties as described, in the absence of the Regional Lead including responsibilities related to day-to-day staffing, assignments and serving as an expert resource for staff. Performs case management activities and assumes the role of Case Manager as needed.

ESSENTIAL DUTIES AND RESPONSIBILITIES
  • Leads the daily operations of the Case Management department by maintaining appropriate staffing levels and adjusting assignments to meet the needs of the department and hospital.

  • Directs the department staff which includes orientating, training, mentoring, supervising and assessing competency. Assists in the hiring interview process and provides input into staff annual performance evaluations.

  • Collaborates with the System and Regional Leads of Case Management by contributing to strategic initiatives, individual hospital budgets, policies and guidelines.

  • Establishes and promotes relationships with clinical team members, physician advisor, chief medical officer and individual physicians to promote care coordination, effective utilization of resources and discharge planning.

  • Maintains an active awareness of regulations and practice standards so that the local lead can contribute to the development of physician strategies related to documentation and resource management.

  • Contributes to performance improvement initiatives by gathering data, performing audits and monitoring performance. Also supports the analysis of data and presenting information to the case management team.

  • Serves as an expert resource in Case Management and functions as a Case Manager or Social Worker with a specific case assignment when needed.

  • Facilitates the review of long stay and observation cases in conjunction with the Case Management team and Physician Advisor.

  • Manages cases on the claim hold and denials logs to ensure that they are kept up-to-date and the information related to delays in billing and denials are trended and shared with leadership.

  • Partners with system leaders, community agencies, vendors and payers to ensure that appropriate and effective relationships are maintained throughout the continuum of care.

  • Acts on behalf of the Regional Lead in his/her absence.

    This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. Other duties may be assigned.

    QUALIFICATIONS

    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    Education and/or Experience

    Bachelor's degree in Nursing, Master's degree in Social Work, or Master's degree in Health Administration with RN license required. Minimum three years of experience as a care manager in an acute care setting required.

    Computer Skills

    Proficient in Microsoft Office software (Word, Excel and PowerPoint).

    Certificates, Licenses, Registrations

    Must be a Registered Nurse or Licensed Clinical Social Worker.



  • Business Unit: Presence St Francis Hospital

    COMPANY OVERVIEW:

    EOE of Minorities/Females/Vets/Disability
    Presence Health 
    Location: EvanstonIL 60202
    Document ID: AC296-0IOY  
    Job Type:  Regular

    Job Schedule: Full-time


    Posted on: 2018-09-2409/24/2018
    2018-10-24
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