Manager Care Management, Req #47505

Christiana Care Health System - Newark, DE4.1

Full-time

We have an exciting leadership opportunity for a Care Manager/Utilization Manager for our Case Management Team. This position will manage people and the daily operations of longitudinal care management, precertification, utilization management, appeals and denials for at risk populations within Christiana Care Health System.

Responsibilities:

Evaluates and provides feedback/recommendation of information technology software that allows for comprehensive, longitudinal care management of an identified population of patients.

Facilitates the development of care management guidelines, algorithms and protocols.

Develops and implements applicable care management processes, policies, and procedures.

Manages daily operations of the Care Management Team.

Prepares and reviews annual performance appraisals with employees.

Develops systems and processes to effectively manage collaborative relationships with external third party payers.

Identifies areas of potential compliance risk and develops strategies to mitigate risk in collaboration with the Compliance Officer and staff.

Maintains strong working relationship with compliance office and staff and actively engages in all compliance activities as requested.

Assists in the preparation the annual operating and capital budget

Develops processes for the accurate capture of data in order to maintain a care management dashboard reflective of key performance measures.

Collaborates with Data Informatics team to analyze data and makes recommendations for program development/changes based on data analysis.

In collaboration with the key internal stakeholders, develops and implements processes, policies, and procedures to effectively and efficiently manage the transition of patients in accordance with state, federal and payer standards and regulations.

Demonstrates knowledge of local, state, and federal reimbursement guidelines.

Serves as an expert resource for staff and Christiana Care leadership related to care management functions.

Coordinates and facilitates department meetings.

Maintains a collaborative professional relationship with clinicians and administrative staff necessary to develop, implement, and evaluate successful process outcomes.

Collaborates with program medical director as needed.

Education and Experience Requirements:

  • Registered Nurse Licensure.
  • BSN required.
  • Five years’ experience in both Utilization Management and Case Management
  • Three years’ supervisory/management experience
  • Experience with third party contacting.
  • Knowledge of URAC, HEDIS and/or NCQA standards, outcome analysis, project management and data systems required.
  • CEUs must be maintained related to licensure requirements.

Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.

Christiana Hospital, Newark, Delaware.

This 1,007-bed, 1.3-million-square-foot modern facility provides a level of care only available in large-scale teaching hospitals. Christiana Hospital includes Delaware's only Level-I Trauma center (as verified by the American College of Surgeons), which is prepared to handle the most extreme medical emergencies. In fact, it is the only Level-I Trauma center on the East Coast corridor between Baltimore and Philadelphia. Christiana Hospital has also been nationally recognized in U.S. News & World Report's Best Regional Hospitals rankings as #1 in Delaware and #3 in the Philadelphia metro area, plus High Performing in 9 Adult Procedures/Conditions.

Job Type: Full-time

Experience:

  • retail management: 1 year (Preferred)