Care Management Manager - Case Management

Position Summary

The Care Management Supervisor leads the care management team in coordinating patient care, promoting appropriate use of hospital resources, and ensuring effective discharge planning. This role oversees care coordination activities to support safe transitions to the next level of care while enhancing patient outcomes and operational efficiency.

Baptist Health Princeton Hospital

Serving our neighbors for more than a century, Baptist Health Princeton Hospital in Birmingham is a 505-bed facility dedicated to a patient-first approach.

A recognized leader in aortic valve surgery, COPD, heart attack, heart failure and stroke, we provide fast, lifesaving response times for patients with chest pain or stroke symptoms. Our full range of services includes comprehensive emergency room care; cardiovascular care, including structural heart and valve care; orthopedics, including rehabilitation; a comprehensive sleep center; a comprehensive bariatrics center, providing surgical and nonsurgical weight-loss procedures; and women’s care for all stages of life.

We have achieved Primary Stroke Center certification from The Joint Commission and accreditation from the American College of Surgeons Commission on Cancer and from the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). At Baptist Health Princeton Hospital, we are committed to contributing to the future of healthcare through our clinical research and medical residency program.

Baptist Health Princeton Hospital offers great NEW competitive pay and benefits!

• Medical, Dental, Vision
• 403(b) Retirement Savings Plan w/matching
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• Paid Time Off (up to 5 weeks to start)
• Life Insurance
• Extended Leave Plan (ELP)
• Family Care (childcare, elder care, pet care)
• Educational Benefits including tuition reimbursement & monthly payments to help pay down any graduated school debt

ALL benefits start on day one!

POSITION SUMMARY

Leads the care management team in facilitating appropriate use of hospital resources and effective discharge planning and coordination of services to transition patients to the next appropriate level of care.

 

Responsibilities

What you will do

• Manages educational, financial and human resources for the care management teams to deliver high quality, cost effective, and responsive patient-focused health care services.
• Coordinates the workload distribution and scheduling of the care management team members to assure adequate and appropriate staffing to meet the needs of patients and families within the Baptist Health network.
• Develops collaborative relationships with the site leadership, medical staff leadership, managed care contractors, and community leaders.
• Supports positive relationships with payors and develops plans to optimize reimbursement and quality of care.
• Monitors working DRGs and GMLOS assignment as appropriate.
• Implements the performance improvement process to include outcome measurement as it relates to the identification of processes/ strategies/ opportunities that promote population health.
• Achieves results by developing strategies to manage patient care across the continuum, focusing on high risk, high cost and problem prone areas to include patient at risk for re-admission.
• Supports processes for clinical quality/ cost-improvement initiatives/ preventing re-hospitalizations.
• Develops recommendations to expand the integration of post-acute care services and hospital operations to better meet the needs of Baptist Health and the community.
• Designs educational strategies to assure compliance with regulatory standards for NCQA, HIPAA, CMS, and other local, state and federal organizations as applicable.
• Coordinates budget implementation with regard to payroll, supplies and miscellaneous other functions that deal with the financial performance of the departments overseen,
• Serves as a department intermediary for service problems.
• Ensures incident reports are completed appropriately and follows up with incident reports as needed.
• Organizes/ leads staff meetings and huddles.
• Embraces, promotes and communicates change.
• Demonstrates professional accountability by maintaining proficiency in assigned role and involvement in professional organizations and continuing education.
• Holds self and others accountable to Baptist Health’s mission, vision and values.
• Develops and recommends concepts relative to new business opportunities, subsidiary organizations, acquisitions, current business design or other organization structuring to optimize organizational strength and meet operating mission.
• Manages various human resources functions including hiring, work assignments, coaching plans, and performance counseling.
• Maintains reasonably regular, punctual attendance consistent with Baptist Health policies, the ADA, FMLA and other federal, state and local standards.
• Maintains compliance with all Baptist Health policies and procedures.
• Knowledge of hospital and department policies and procedures as well as knowledge of regulatory requirements relevant to the care management department.
• Ability to compile, analyze and interpret data to include the advanced application in spreadsheet generation and the use of graphics, database management and word processing software.
• Serves as facilitator to physicians and nursing staff on utilization and discharge planning, care coordination, and utilization management issues.
• Demonstrates the knowledge of labor and expense budgets, as well as revenue and census projections/ development.
• Maintains confidentiality of data and information.

Qualifications

• Graduate of an approved school of nursing Required or
• Masters in Social Work (MSW) Required or
• Masters in Mental Health Counseling (MHC) Required or
• Masters in Marriage and Family Therapy (MFT) Required
• 3 Years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care Required
• 2 Years in utilization management. Preferred
• Alabama RN license required and maintained current if graduated from an approved school of nursing

Qualifications

Qualifications

• Graduate of an approved school of nursing Required or
• Masters in Social Work (MSW) Required or
• Masters in Mental Health Counseling (MHC) Required or
• Masters in Marriage and Family Therapy (MFT) Required
• 3 Years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care Required
• 2 Years in utilization management. Preferred
• Alabama RN license required and maintained current if graduated from an approved school of nursing