Manager - Chmc Utilization / Case Management

Responsibilities

Responsible for the development of staff and systems to effectively operate a comprehensive Case Management Program. Provides leadership and supervision to case managers, social workers, case management coordinators/discharge planners, utilization review coordinators and utilization review technicians. Assesses needs and plans, communicates and designs services that are appropriate to the hospital mission and patient/family needs. Integrates and coordinates services using continuous quality improvement tools. Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.
Qualifications

Education and Work Experience
Licensed clinician in your state.
Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school of Social Work for Licensed Clinical Social Worker.
Minimum 5 years experience in a Case Management position.
Must have analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process.
Experience and knowledge in basic to intermediate computer skills.
Behavioral Violence Prevention Training within 3 months of hire and maintain current
Certification in Case Management, BS or BSN or related field preferred.
Current BCLS (AHA) certificate preferred.
Knowledge of Milliman Criteria and InterQual Criteria preferred.
We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.