Employment Type:

Full time

Shift:

Day Shift

Description:

Job Title:

Manager Care Mgt & Util Review

Employment Type:

Full Time

Shift:

Day

(SUMMARY) Position Highlights:

• Competitive pay

• Additional Benefits: Relocation assistance, tuition reimbursement, free parking

• Quality of Life

• Advancement: Opportunities to advance through the Clinical Advancement Program

• Location: Holy Cross Health has two hospitals and four healthcare centers all a short driving distance from Washington DC and Baltimore, MD

Description:

• Full-Time 8am – 4:30pm

• Reporting to the Director of Care Management

• The RN Manager is responsible and accountable for the operational management, leadership, professional development and quality assessment and improvement activities of the department, particularly the Care Managers. Manages the activities of RN Case Managers for in inpatient care coordination and utilization review. Oversees interactions of staff with outside activities and agencies on regulations affecting patient status and insurance.

Responsibilities:

• Works collaboratively with the Nursing Director and Sr. Director of Care Management

• Conduct clinical supervision with all case managers and serve as a resource for the team.

• Responsible for the compliance, tracking and trending of incident reporting procedures

• Attend daily huddle/weekly interdisciplinary team and administrative meetings.

• Manage the daily operations of the Nurse Case Managers and serve as a resource for the team

• Collaborates and maintains positive working relationships with physicians, physician advisor and external review organizations to ensure quality outcomes, patient throughput, and appropriate resource utilization while supporting the HCH mission.

• Assists with the denials prevention and management staff to ensure a low medical necessity denial rate. Supports the Mission of Trinity Health and Holy Cross Hospital.

What you will need:

• State of Maryland license as a Registered Nurse

• BSN required; MSN Degree preferred.

• At least 3 years of experience in hospital case management or related activity.

• Minimum of 1–3 years management/supervision/leadership experience in an acute healthcare setting required.

• Extensive knowledge of payer mechanisms and clinical utilization management is required

Preferred:

• At least 5-7 years clinical of Nursing experience in an acute healthcare setting.

• Designation Changes and Utilization Review

• Knowledge of pertinent regulatory, accreditation, public and private service organizational activities relating to discharge planning and resource utilization. Evidence of prior successful interaction with external review organizations. Demonstrated ability to establish and maintain effective interpersonal relationships with all levels of personnel, medical staff, and community, as well as a demonstrated ability to work effectively with interdisciplinary teams.

About us:

Holy Cross Health is a Catholic, not-for-profit health system that serves more than 240,000 individuals each year from Maryland's two largest counties — Montgomery and Prince George's counties. Holy Cross Health earns numerous national awards, clinical designations and accreditations across a wide range of specialties for providing innovative, high-quality health care services.

We were named one of America’s 100 Best Hospitals for 2022.

Holy Cross Health is an Equal Employment Opportunity (EEO) employer status.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran