Oversees the day-to-day activities of the Discharge Care Management team; this team is engaged in discharge planning for WellCare members to ensure a safe and effective transition from an inpatient setting to an appropriate lower level of care. Monitors productivity and quality of outbound calls, inbound calls, discharge planning and communication with concurrent teams, timeliness of referrals, and documentation according to policies and procedures. Manages the team's E-time and attendance. Ensures appropriate workload distribution. Handles escalated issues as needed.
Reports to: Dir. Utilization Management
Department: Health Services-NE
Location: Untied States
- Supervises a team of Discharge Care Managers who are engaging in telephonic coordination of discharge plans to transition members from an inpatient setting to an appropriate lower level of care, assessing members' clinical and social needs, and developing individualized care plans which will provide a stable and supportive post-acute care environment.
- Acts as primary contact for escalated calls and/or escalated issues that require additional research or special handling.
- Monitors associate performance and conducts counseling/corrective action procedures when required. Identifies concerns, brings issues to management's attention and offers suggestions for improvement.
- Provides significant input to performance evaluations, hiring and termination decisions for associate in work group.
- Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates
- Provides training and guidance to new and current Discharge Care Managers regarding policy & procedure, systemic tools, workload and care plan development.
- Answers all questions and assists peers and management with delegated tasks or projects.
- Takes the lead in preparing and submitting projects, reports or assignments as needed to meet department initiatives and/or objectives.
- Ensures phone or team coverage due to fluctuations in staffing levels.
- Ensures regulatory requirements and accreditation standards are applied to all activity and reporting.
- Plays an active role in creating, applying and utilizing accepted policies and procedures.
- Attends company meetings in absences of manager or director.
- Performs special projects, tasks and/or other duties as assigned
- Required An Associate's Degree in Nursing or Graduation from Diploma Nursing School
- Preferred A Bachelor's Degree in Nursing or related field
- Required 4 years of experience in an acute clinical care setting and/or MCO related experience
- Required 2 years of experience in current case management
Licenses and Certifications:
- Intermediate Ability to drive multiple projects
- Intermediate Ability to work independently
- Intermediate Demonstrated time management and priority setting skills
- Intermediate Ability to work in a fast paced environment with changing priorities
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Demonstrated written communication skills
- Intermediate Ability to create, review and interpret treatment plans
- Intermediate Demonstrated negotiation skills
- Intermediate Ability to lead/manage others
- Advanced Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
- Advanced Ability to effectively present information and respond to questions from families, members, and providers
- Advanced Ability to effectively present information and respond to questions from peers and management
- Advanced Knowledge of healthcare delivery
- Intermediate Ability to implement process improvements
A license in one of the following is required:
- Required Licensed Registered Nurse (RN)
- Preferred Certified Case Manager (CCM)
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Word
- Required Intermediate Healthcare Management Systems (Generic)
- Preferred Other Bilingual skills