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POSITION SUMMARY

The lead case manager provides direct supervision to Case Management personnel, promote the progression-of-care; and monitors the patient's progress to ensure that the plan of care and services provided are patient focused, high quality, evidence based, appropriate to patient needs, efficient, and cost effective.

Works closely with the entire team to educate and facilitate communications relating to payer and reimbursement requirements and methodologies.

ENTRY REQUIREMENTS

A Bachelor’s degree in a clinical healthcare discipline such as nursing, medicine, social work, respiratory or physical therapy, or other related allied health field.

Comparable experience will be considered in lieu of a bachelor’s degree.

Five years’ experience in an acute care hospital and knowledge of hospital operations

Two years current case management experience required

Licensed as a registered nurse, social worker or other healthcare discipline. ACM or CCM certification preferred .

If Registered Nurse, must be licensed to practice in Michigan. Also, for those hired into this job after January 1, 2015, it is required to obtain a BSN within 5 years of start date.

Knowledge of Case Management Society of America’s case management standards of practice. Eligible to sit for, and successfully pass, the test for certification as a Certified Case Manager (CCM) or Accredited Case Manager (ACM) within 2 years of employment

The Case Management Team Leader must possess strong communication and interpersonal skills, leadership, negotiation skills, good leadership talent.

Demonstrates exceptional professional role model behavior that supports initiatives in a positive and consistent manner.

Strong organizational and follow up skills

Assertive and effective interpersonal skills

Demonstrable understanding of customer expectations.

Clear understanding of relationship marketing.

Demonstrates ability to organize, identify, change priorities and be flexible in

Demonstrates ability to lead/direct others through positive role modeling, honesty, integrity, direct communication, inspiration, and holding self- accountable.

Demonstrates participation in organizational and / or unit based process improvements inititiatives.

SPECIFIC DUTIES

+ Supports the Mission, Vision and Values of Munson Healthcare

+ Embraces and supports the Performance Improvement philosophy of Munson Healthcare.

+ Promotes personal and patient safety.

+ Has understanding of Relationship-Based Care (RBC) principles, meets expectations outlined in Commitment To My Co-workers, and supports RBC unit action plans.

+ Uses effective customer service/interpersonal skills at all times

+ Conducts daily huddles with Case Management (CM) team to discuss ongoing challenges.

+ Maintains a knowledge base of all insurance reimbursement criteria.

+ Maintains knowledge of managed care contracts

+ Collaborates with nursing, infection control, risk management and quality improvement through case monitoring.

+ Collaborates with business office to ensure that accurate and complete registration information is captured and communicated to case managers

+ Consults with members of the access center to develop preliminary treatment plans in conjunction with attending physician requests and insurer expectations.

+ Observes interactions between individual case managers and patients, families and physician and provides positive feedback or constructive advice.

+ Consults regularly with Program Manager.

+ May assist Program Manager to provide in-service education to patients, hospital staff and community.

+ Projects a positive image to patients, families and hospital associates.

+ Supervises job performance of case managers and support staff as needed.

+ Holds end of week team meetings to review lessons learned and to share events.

+ In conjunction with support staff, establishes and maintains department productivity reports and data collection procedures.

+ Consults with program director about program budget, process modifications, practices, procedures, and outcomes.

+ Participates in weekend and holiday rotation schedule with case managers.

+ Participates in community activities as needed.

+ Educates, reinforces and directs staff to consistently identify, report progression of care delays and to proactively intervene to overcome delays whenever possible.

+ Performs other duties as required