Mgr Utilization/Case Mgmt

Allina Health - Coon Rapids, MN

Full-time
Introduction

Allina Health is dedicated to the prevention and treatment of illness and enhancing the greater health of individuals, families and communities throughout Minnesota and western Wisconsin. A not-for-profit health care system, Allina Health cares for patients from beginning to end-of-life through its 90+ clinics, 12 hospitals, 16 pharmacies, specialty care centers and specialty medical services that provide home care, senior transitions, hospice care, home oxygen and medical equipment, and emergency medical transportation services. Allina Health is a vibrant, growing organization with opportunities to suit your professional skills and a diverse work environment to match your specific interests. We believe employees are our greatest asset and are dedicated to helping you develop and maximize your professional skills.

Mercy Hospital is the premier hospital in the northern metropolitan communities of the Twin Cities. It is located on two campuses: one in Coon Rapids, and one in Fridley. Together, these facilities offer nationally recognized clinical excellence and compassionate health care services, including cancer care, heart and vascular services, emergency and trauma care, surgical services and da Vinci® System, The Mother Baby Center at Mercy with Children’s Minnesota, Bariatric Surgery Center of Excellence, the Joint Replacement Center and women’s and children’s services. In 2016, Mercy Hospital was named one of the nation’s 100 Top Hospitals and 50 Top Cardiovascular Hospitals in the U.S. by Truven Health Analytics. With 3,500+ employees, 830+ affiliated physicians and 420 staffed beds, Mercy Hospital provides inpatient and outpatient services to more than 270,000 patients each year.

Responsibilities

Manages daily operations of the CM staff and work flow processes to ensure compliance with regulatory requirements and third party payer contracts, denial management, problem solving and resolution.
Responsible for hiring, onboarding, assuring ongoing competency and evaluation of RN Care Coordinator staff.
Serves as leader and content expert to the broader Care Management Department, Compliance Department, operational leaders and physicians specific to Utilization Management, relevant compliance and practice issues.
Design work processes and direct work performance to be compliant with all rules and regulations, accreditation standards and laws that apply, specifically to include billing compliance in order to avoid activities that constitute fraud and abuse.
Effective working relationships are maintained with 3rd party payers on issues regarding LOS management, resource utilization and contractual requirements for covered patients.
Develop operating budget, monitors variances, manages productivity specific to the CM functions and takes appropriate action to meet defined targets.
Provides leadership in the development and implementation of key practice and compliance areas for improvement including patient admission stauts, Length of Stay, Readmissions and CMS’s Target Areas.

Facilitates and supports staff in their involvement in assuring the appropriate progression of care and accurate transition plans for complex medical patients.

Education

B.S or B.A. in Nursing or related field required, Masters level preferred.

Qualification/Skills

Minimum of 3 years experience with Case Management / Utilization Management/Utilization Review (UM/UR); particularly in the areas of assessment and determination of level of care.
Three to five years of experience working in a healthcare setting across multiple clinical specialties.
Minimum of three to five years related to management of personnel and department operations preferred.
Strong experience/understanding of patient care processes and work flow. Acute care experience preferred. Operational/day to day leadership in a healthcare or related field.
Demonstrated leadership and project management experience including interdisciplinary participation.
Ability to work independently and collaboratively with other healthcare professionals; effectively communicating, building relationships, and negotiating with physicians, internal departments and external customers in the areas of CM to achieve desired outcomes.
Knowledge and understanding of HIPPA, managed care/CMS/Medicaid requirements for hospitalization, continued stay of patients and other regulatory requirements.

Work Schedule

Management schedule- generally Monday - Friday with limited variation depending on department needs.

Location/Community Information

The city of Coon Rapids is a fast growing community on the Mississippi River just 20 minutes north of Minneapolis-St. Paul, and the metropolitan area gateway to the northern part of the state. Coon Rapids offers excellent access to highways, dynamic community shopping centers with major retail anchors, and a wide variety of recreational activities including neighborhood and regional parks, a municipal golf course, indoor ice arenas, hiking and biking trails and swimming pools.

Coon Rapids:
Located 14 miles North of Minneapolis and 20 miles Northwest of St. Paul
Population = 63,000
Service area = 413,500

Community Resource Links:
Community Information School Digger

Explore MinnesotaMN Dept of Education

Minneapolis St. Paul MagazineSt. Paul Pioneer Press

Twin Cities Living MagazineStar Tribune

Closing

If you are interested in becoming part of our award winning team of professionals, please apply online today. Allina Health is committed to providing Equal Employment Opportunities to all employees and applicants. EO M/F/Disability/Vet Employer.