Manager RN-Care Coordination

Overview: The Care Coordination Manager, under the direction of the Director of Case Management, is responsible for coordination of the medical care coordination program by directing the following functions: Utilization Review, Denials and Appeals, Care Coordination, and Clinical Documentation Improvement.
Collaborates closely with the Medical Social Service Manager to support an integrated discharge planning team.
Collaborates with all disciplines, medical staff, departments, payers, system partners, vendors, and community agencies to reduce risk and optimize clinical outcomes within best practice, ethical, legal, and regulatory parameters.
The Care Coordination Manager, under the direction of the Director of Case Management, assists in the attainment of hospital goals, recommends policies and practices to improve the quality of services provided by the organization, and assists with the hospital performance improvement activities.
The Manager coordinates educational opportunities and continued learning for patient care coordinators, utilization management staff, medical staff, and others regarding information that pertains to clinical resource utilization/case management and optimal discharge planning.
The Manager provides leadership and positive promotion of the continuum of care from acute care through outpatient programming with linkage to community resources.
Experience in program development and outcomes management preferred.
Why UnityPoint Health? Culture – At UnityPoint Health, you matter.
Come for a fulfilling career and experience a culture guided by uncompromising values and unwavering belief in doing what's right for the people we serve.
Benefits – Our competitive Total Rewards program offers benefits options like 401K match, paid time off and education assistance that align with your needs and priorities, no matter what life stage you’re in.
Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.
Development – We believe equipping you with support and development opportunities is an essential part of delivering a remarkable employment experience.
Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve.
Hear more from our team members about why UnityPoint Health is a great place to work at https://dayinthelife.
unitypoint.
org.
Responsibilities: Leadership Builds trusting, collaborative relationships with staff, peers, physicians and administration to advance the core continuum of care business strategy Applies HR practices fairly and consistently.
Ensures a thorough and adequate orientation program for new staff Ensures the adequate competency training and continuing education programming is done to meet identified staff development needs.
Supports department and hospital shared governance infrastructure and staff engagement.
Supports continuous staff development and career goal achievement.
Commits to the hours needed to achieve outcomes and develop others to assure round-the-clock leadership.
Requires flexibility with hours worked and shifting priorities as the environment changes, without losing sight of goals/outcomes.
Follows-up on patient concerns as soon as possible.
Notifies Director and/or Administration of concerns that have the potential to escalate or lead to Risk Management concerns.
May be requested to travel to conferences and meetings as a hospital representative.
Must be able to make arrangements to attend these as required.
Participates in the determination, definition, and periodic evaluation of the Case Management Dashboard, using data to better understand strengths and weaknesses of the hospital and department, and to determine needs, decisions, and strategies Reviews and recommends annual updates to the Utilization Management Plan.
Ensures timely review of hospitalized patients using designated criteria or other, as appropriate.
Facilitates consultative reviews with care coordinators and contracted services if admission or continued stay criteria are not met, assuring appropriate and timely level of care status.
Ensures the facilitation of multidisciplinary and complex care rounds for those patients with significant discharge barriers.
Utilize change theory for the implementation of organizational changes.
Serve as a change agent, assisting others in understanding the importance, necessity, impact and process of change.
Communication Build credibility with providers as a champion for patient care, quality and professional practice and utilization management Collaborate with medical staff to implement evidenced-based practice and process improvement (protocols, policies, and procedures).
Partner with Physician Advisor(s) and other physician leaders to assist in driving the continuum of care and Utilization Management strategy.
Prioritize building provider relationships with key strategic partners.
Establishes effective communication systems and forums with third party payers, Medical Records, and the Managed Care and finance offices Knowledge of Healthcare Environment Support Patient Flow initiatives that optimize patient length of stay, assures timely patient throughput and ensures appropriate discharge planning.
Identify opportunities to appropriately coordinate services between transitions Business Skills Educate patient care team members on financial implications of patient care decisions and continuum of care (i.
e.
length of stay, reimbursement, risk reduction, readmissions).
Identify future skill sets needed to remain competitive.
Measure and analyze performance from various perspectives, i.
e.
customer, staff, growth and development, business and fiscal.
Utilize hospital database management, decision support, and expert system programs to access information and analyze data from disparate sources for use in planning for patient care processes and systems.
Participates in development of annual and multiyear capital budget.
Participates in development of annual operational budget to support strategic plan.
Executes successfully the established plan and the service through measurement, monitoring, analysis, reporting and adjusting the direction, allocation and utilization of available resources.
Qualifications: Successful completion of an accredited nursing program BSN At least three years of professional experience as a direct care clinician or case manager preferred.
Possess current RN licensure in the State of Iowa Successful completion of an accredited nursing program Writes, reads, speaks, and comprehends fluent English Ability to direct others and to exercise judgment in problem-solving scenarios Ability to lead and/or participate in multidisciplinary teams Possess a comprehensive knowledge of general nursing theory and practice and an expanded knowledge of current clinical and specialized patient care concepts.
Possess a broad and varied knowledge base that is continually enhanced through self-directed study and participation in educational opportunities.
Possess knowledge of performance improvement and quality standards.
Possess knowledge of The Joint Commission and other regulatory standards.
Ability to complete basic computer course through in-hospital training; develops and maintains necessary computer skills including Word and Excel.
Use of usual and customary equipment used to perform essential functions of the position.