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Care Management Manager-LGH Case Management-Full Time

Lafayette General Medical Center

This is a Full-time position in Lafayette, LA posted May 3, 2021.

Lafayette General Health takes to heart our mission: To Restore, Maintain and Improve Health of people in the communities we serve.

And we could not do that without the best healthcare staff in Louisiana.

We invest in our employees and help them achieve their professional goals.

When you join the team at Lafayette General Health, you gain more than just a job.

You gain the support of leaders across the system that help mentor you and guide you to your ultimate passion and career potential.

Whether you want to be part of a teaching hospital, the largest acute care facility in the region or a rural community facility, we will make sure you’re right where you are meant to be!

If you have any questions or issues regarding the application process, please email recruitment@lgh.org or call 337-289-8446.

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Care Management Manager-LGH Case Management-Full Time (Job ID: 4489)

Location: LGMC
Employment Status: FT
 

SUMMARY:

The Care ManagementManager uses skilled intervention, clinical best practice knowledge andcollaboration with the patient, physician and multidisciplinary treatment teamto concurrently pace care, achieve quality outcomes and negotiate appropriatereimbursement.

Ensures the timely and seamless clinical transition of patientsthrough medically appropriate levels of care.

Care Management Manager willidentify potential barriers to patient care throughout their stay and promotequality outcomes.

Responsible for setting department goals, reviewingdepartment goals, and maintaining department scorecards and dashboards.Responsible for directing employee evaluations and administering performanceimprovement plans as necessary.

Consistentlydemonstrates support of LGH’s Mission and Philosophy, and upholds LGH’sstandards of behavior by striving for excellence, contributing to the teamefforts and showing respect and compassion for patients and their families,fellow employees, and all others with whom there is contact at or in theinterest of the institution.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

· Oversight of CareManagement

o Supervise andprovide feedback to director as necessary

o Maintainappropriate unit staffing according to census and acuity

o Work with HumanResources to manage new staff hiring

o Manage paid timeoff requests and schedule

o Relay keyhospital developments or unit decisions to staff

o Hold staffaccountable to metrics, work quality and attendance for all meetings

o Ensures thatdepartmental measures for processes and expectations are carried out on a dailybasis

o Prioritize anddirect staff efforts for the high-risk patients

o Meet with staff1:1 on a rotating schedule quarterly

o Collaborate withcommunity post
– acute providers, community agencies, and vendors

o Remain current onCenters of Medicare and Medicaid Services (CMS) regulations

o Sign up for CMSlist serve for updates

o Monitor changesin payer policies and procedures and inform staff of any changes

o Supervises andcoordinates inpatient case management

· Outpatient OBSManagement

o Ensure allpatients are in the appropriate status with appropriate documentation forassigned patients, regardless of payer

o Identify patientswith barriers to discharge those at high risk of readmission, outlier patientsor complex patients.

o Escalate cases tophysician advisor and/or Utilization Management Committee physicians when caseis not meeting status

· OutlierManagement

o Facilitate weeklyUM meeting

o Assist staff indeveloping solutions to improve patient flow and throughput

o Escalate issuesto Care Management Director

o Coordination andCommunication

o Representinterests of care management in high level discussions with nursing,physicians, financial and administrative leadership

o Communicateweekly care management metrics to staff and Care Management leadership groups

· DenialsManagement

o HoldAppeals/Denials coordinator accountable for workload

o Identifyopportunities to reduce clinical denials with Appeals/Denial coordinator

o Partner withrevenue cycle on denial management opportunities and high dollar cases

o Staff Development

o Address staffingtraining needs based on staff feedback and information obtained during rounds

o Utilize a CMEducator calendar to provide consistent education plan

o Support staffdevelopment through internal and external training for continuous learning asdepartment budget allows

· ProductivityManagement

o Reviews the dailyproductivity of the department

o Collaborates withIT on creating CM department scorecard and individual staff scorecards

o Distributesscorecards to departments

o Sets departmentand individual goals

o Maintains aneffective performance improvement program

o Maintains payrolland acts as primary timekeeper for all Care Management staff

· Performsall other duties as assigned

The abovestatement reflect the general duties considered necessary to describe theprinciple functions of the job as identified and will not be considered asdetailed description of all of the work requirements that may be inherent inthis position.

EDUCATION/TRAINING/EXPERIENCE:

· RN or LMSW/LCSW required and licensed in the State of Louisiana

· Maintains state license and/or certification in one’s own profession

· Prefer a minimum of 5 years’ clinical work experience

· Knowledge of regulatory agencies, managed care principles, and contractterminology

· Working knowledge of Microsoft Office Suite (Word, Excel, PowerPoint)

· Strong interpersonal and communicating skills

· Ability to work both independently and within a group setting

· Ability to assess patient’s overall situation (medical, psychological,financial) and develop an actionable discharge plan

· Organizational skills with ability to prioritize tasks

· Ability to lead and direct a large team

· Experience in analyzing data and aggregating reports

EQUIPMENT OPERATED:

· Computer

· Various

PHYSICALDEMANDS AND WORKING CONDITIONS:

· Continuous sitting or walking with small amount of liftingor carrying

· Average or periodical contact with conditions such asfumes, noises, chemicals, hazards and/or diseases.

More than average noise dueto the intermittent operations by several employees completing their duties inthe same work location

· Requires flexibility in work schedule.

Routinely a 40-hourworkweek, holidays, rotational shifts, and extended hours due to holidayworkload

· Occasional travel may be necessary

SELECTION GUIDELINES:

Formal application;verification of education, and experience; verification of license(s),certification(s), registration(s), accreditation(s) if applicable; oralinterview, reference and background checks; job related tests may be required.

The duties listed above are intended only as illustrations of thevarious types of work that may be performed. The omission of specific statements of duties does not exclude them fromthe position.

The job description does not constitute an employment agreementbetween the Hospital/Clinic and the employee. The job description is subject to change as the needs of the Hospital/Clinicand requirements of the job change.

Qualification Requirements:
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, skills, and abilities required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Must comply with all SERVICE Standards of Behavior
 

Back to Job Listing Job Summary
Position
Care Management Manager-LGH Case Management-Full Time
Category
Allied Health/Patient Care Services
Employment Type
Employee
Post Date
10/26/2020
Salary
Negotiable
Close Date
02/23/2021
Location
US:LA:Lafayette

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1214 Coolidge Street,Lafayette,LA,70503,US

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Care Management Manager-LGH Case Management-Full Time (Job ID: 4489)

Location: LGMC
Employment Status: FT
 

SUMMARY:

The Care ManagementManager uses skilled intervention, clinical best practice knowledge andcollaboration with the patient, physician and multidisciplinary treatment teamto concurrently pace care, achieve quality outcomes and negotiate appropriatereimbursement.

Ensures the timely and seamless clinical transition of patientsthrough medically appropriate levels of care.

Care Management Manager willidentify potential barriers to patient care throughout thei

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