Job Category:

Nursing - Registered Nurse

Work Shift/Schedule:

Varies

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

Manages the day to day operations of the department by supporting the case management and interdisciplinary healthcare team in facilitating patient care through the continuum. Monitors department activities to ensure optimum case management, including education, competency and accountability of the licensed staff who provide services to patients. Provides clinical oversight and training in collaboration with the Department Educator and leadership team to ensure staff competence, and develops core case management standards and programs to facilitate optimal patient care and effective transitions to an alternate level of care. Responsible for identifying key performance indicators for the department, ensuring all professional and organizational standards are kept, and ensuing organizational and staff accountability. The Manager will also be responsible for recruitment, hiring, staff development, performance improvement, and progressive discipline as necessary. In addition, program planning, budgeting, and longer term strategic planning for the department in keeping with organizational vision and goals are significant aspects of this role. This position will come in contact with patients in the neonate, infant, child, adolescent, adult, and geriatric age groups.  Employee performs clinical duties in accordance with population specific guidelines and adheres to National Patient Safety Goals as outlined in policy and procedures.  Provides cross coverage in all settings as required in the care continuum, including weekend rotation.

Minimum Job Qualifications

• Licensure or other certifications: Professional licensure or national certification in health and human services. CCM (Case Management Certification) or ACM (American Case Management Certification) required within 18 months of date of hire.
• Educational Requirements: Bachelors Degree in Nursing or other baccalaureate degree in Health or Human Services. Eligibility requirements for certification: 12 months full-time case management experience supervised by a certified case manager, or 24 months full-time case management experience not supervised by a certified case manager, or 12 months full-time supervisory experience as a supervisor of individuals who provide Case Management.
• Minimum Experience: Five years of experience indirect patient care and/or case management. Financial and management experience required.  Must be able to make independent decisions which directly affect the institution both clinically/financially and operationally.  Maintains continuing education appropriate to case management and sits for the national certification exam.
• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications:
• Preferred Educational Requirements:
• Preferred Experience: ICD-10 and CPT coding preferred.
• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Assertiveness and effective written/verbal communication
• Ability to affect change and positive relationship building
• Flexibility, problem solving/organizational skills, and promoting patient/family autonomy
• It is critical to have knowledge of funding resource, patient services, and clinical standards and outcomes
• Demonstrate the ability to think 'outside of the box' and consistently create new, and effective solutions to today's problems and opportunities

Essential Tasks and Responsibilities

• Participates in the initial and continuous development of the NGHS Case Management function. Assumes responsibility in the redesign and continuous quality improvement of the NGHS case management function ensuring a balance between cost efficiency and successful clinical outcomes. Participates in the development and implementation of clinical standards of care/patient outcome evaluation tools. Identifies and recommends information systems/mechanisms for patient/resident tracking and comparative data analysis. Explores opportunities for and provides recommendations for organizational standardization. Participates in identifying expanded use of and improvement management utilization of NGHS continuum. Participates in identifying performance standards for staff and incorporate into annual performance evaluation.
• Coordinates and manages day-to-day operations for the case management department and assumes full responsibility and accountability for access and control throughout NGHS continuum. Facilitates a managed care process that analyzes, orchestrates, and delivers a medicine plan of care with a focus on accountability for quality cost benefits consistent with payer, provider and consumer expectations. Oversees daily performance of the case management staff ensuring collaborative relationships with Physicians, patients/families and other professionals focusing on optimal use of and appropriate utilization within each phase of a continuum of services. Assures case Managers serve as the patient’s advocate to obtain necessary funding, treatment alternatives, timeliness and coordination of health services, and frequent re-evaluation of progress toward goals. Maintains accountability for access control and timely execution of patient movement through the continuum. Works closely with the Physicians to identify and implement clinical practice that improve patient outcomes and reduces healthcare costs. Participates in data collection and identifying clinical/financial/social factors that would advance/support the practice of case management. Assures and is accountable for the complete and accurate data tracking by staff through on-line systems. Monitors “lightening rounds” patient/family conferences and assures appropriate collaboration/integration of patient services. Monitors appropriateness of Case Managers documentation ensuring concise information that reflects patient’s plan of care.
• Ensures financial improvement performance of NGHS. Maintains accountability for timely precert/recertification activity and minimizes the organization’s financial risk for penalty. Maintains weekly inpatient unbilled accounts and meets organizational financial targets. Assures concurrent financial management of the patient’s account focusing on a balance between cost and reimbursement. Provides case-by-case contract negotiations where indicated. Maintains responsibility for third party appeals process. Provides annual financial enhancement to NHGS above and beyond budgetary requirements.
• Participates with director in administrative responsibilities for the department. Approves payroll and assures appropriate tracking of employee records. Participates in the interviewing and hiring process for vacant positions and assures appropriate staff disciplinary action/documentation. Identifies staff educational needs and arranges for appropriate education to maintain staff competencies. Prepares work schedules and arranges daily coverage on all areas of responsibilities.
• Consistently demonstrates a 'sense of urgency' in his/her work, while mindful of the pillars and financial stewardship opportunities.

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
• Vision: Moderate, Frequently 31-65% of time
• Kneeling/Stooping/Bending: Occasionally 0-30%
• Standing/Walking: Occasionally 0-30%
• Pushing/Pulling: Occasionally 0-30%
• Intensity of Work: Occasionally 0-30%
• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. 

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.