This job provides leadership for the case/care management team. This job collaborates with case managers and ancillary service personnel to ensure quality, evidence based care management resources are used to improve the overall quality for patients.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.

This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion.
 

Education 

Required - Registered Nurse Diploma OR Master's Degree in Social Work

Work Experience

Required - 3 years experience in Case Management/Care Management (Disease Management) or Utilization Management.

Certifications

Required - Current State of Louisiana Registered Nurse License OR Licensed Master Social Worker (LMSW)

Preferred- Certification in Certified Case Manager (CCM) or equivalent

Knowledge Skills and Abilities (KSAs)

• Must have computer skills and be proficient with Windows-style applications, various software packages specific to role.
• Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals throughout the patient care process

• Must have strong leadership and delegation skills including being able to manage and develop a team.

• Must have strong organizational and time management skills.

• Skills to work efficiently under pressure and set priorities required.

Job Duties

• Manages the daily operations of the department by maintaining appropriate staffing levels and assignments to meet the needs of the department.
• Develops a team who communicates closely with Primary Care Physicians to establish a coordinated effort in achieving health improvement goals.
• Establishes and promotes relations with clinical team members, physician advisors and individual physicians to promote effective quality health care through evidence-based care, effective discharge planning, efficient care coordination, safe transition of care, and quality measures and clinical documentation.
• Researches, selects and promotes adaptation of best practice finding to ensure quality patient care and optimal outcomes. Reviews data and identifies process improvements to remove barriers and ensure the success of the care managers.
• Assesses and interprets Payor/Partner needs using pertinent facts and data to solve a range of complex problems. Meets the plan objectives outlined by Payor/Partners.
• Interviews, trains, motivate, evaluations, and monitors staff performance.
• Adapts behavior to the specific patient population, including but not limited to: respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions and communication style.
• Other related duties as required.

The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.

This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns.

The employer 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, protected veteran status, or disability status.
 

Physical and Environmental Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 

Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects.   (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.

Mechanical lifting devices (carts, dollies, etc.) or team lifts should be utilized.
Must be able to sit and for prolonged periods of time.
Must be able to stoop, bend, reach and grab with arms and hands, manual dexterity.
Must be able to travel throughout and between facilities.

Duties performed routinely require exposure to blood, body fluid and tissue.

The incumbent works in a patient care area; works in an area where patients enter; works directly with patients; and/or works with specimens that could contain communicable diseases. There may be an occupational risk for exposure to communicable diseases.

Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.

The incumbent has no occupational risk for exposure to communicable diseases.

Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.

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Individuals who reside in and will work from the following areas are not eligible for remote work position: Colorado, California, Hawaii, Maryland, New York, Washington, and Washington D.C.

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