Medical Management Manager manages the organization's medical management programs, which may include case management, utilization review, quality management, or community health education programs with the goal of providing high quality, cost effective health care services. Collects and analyzes data on utilization, outcomes, safety, and costs to determine trends and identify problem areas. Being a Medical Management Manager presents findings, proposed solutions, and implementation plans to management. Implements long and short term solutions for improvements in patient care and cost savings. Additionally, Medical Management Manager requires a bachelor's degree. Typically reports to a head of a unit/department. The Medical Management Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Management Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
Rush Copley is seeking a Manager of Case Management and Care Transitions who is a leader with accountability for planning, organizing, staffing, coaching, facilitating, and motivating staff members of the Care Management/Appeals team. This Manager is responsible for the department’s operations including the ED Care Management program, human resources, financial management, and process improvement initiatives. Works with clinical teams and medical staff to evaluate the appropriate utilization of facilities and ensure efficient and effective resource management. Acts in collaboration with other hospital departments to ensure compliance with regulatory requirements including accurate medical necessity documentation, inpatient claim denial review and appeal management. The Manager provides direction and vision for the department and exemplifies the Rush Copley mission, vision, and values and acts in accordance with policies and procedures. This position works closely with all multidisciplinary team members to assure the highest degree of evidenced-based practice is provided, keeping the care and safety of all patients as a top priority.
Must be licensed and currently registered to practice as a Registered Nurse
Education: Earned nursing degree at the baccalaureate level or higher required. Graduate degree preferred. Expected completion within 5 years of hire
Certifications: Specialty certification preferred.
Special Skills: Strong project management and innovation skills. Possesses an in-depth understanding of quality improvement and rapid cycle improvement methodologies. The ability to interact with all members of the interdisciplinary team and to build credible collaborative relationships. Knowledgeable of comparative databases, risk adjustment, statistical process control methods, and decision support tools. Able to work independently with effective follow-through and accountability.
Experience: Experience in Care Management, Utilization Management and Appeals required.