Job description

Position Title:

Manager-Case Management Utilization Review (Pediatrics)

Department:

Case Management

Job Description:

General Description:

Under direction, the Manager of case management supervises the case managers and assists in the management of the department.

Essential Responsibilities:

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

Assesses, plans, facilitates and advocates options and services to meet a patient’s health needs and to promote cost-effective outcomes.
Assists in developing and implementing the Utilization Plan, departmental goals, and departmental policies and procedures.
Evaluates work performance of case manager in collaboration with the Director.
Ensures appropriate case management staffing.
Compiles reports as appropriate.
Ensures compliance with applicable federal guidelines.
Represents the department on assigned hospital committees.
Ensures cost-effective care through utilization management and care coordination.

General Responsibilities:

Performs other duties as assigned

Minimum Qualifications:

Education: Bachelor of Science in Nursing; and

Experience: Three (3) years clinical nursing experience in an acute care facility. One year supervisory experience.

License(s)/Certification(s)/Registration(s) Required: Current RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact RN License (eNLC). Current Basic Life Support issued by the American Heart Association required upon hire.

Knowledge, Skills and Abilities:

Knowledge of nursing practices and procedures. Strong clinical assessment skills. Must be knowledgeable about resources available in the community for use by patients, families and the health care team that would facilitate in the recovery of the patient. Requires knowledge of third party payer issues concerning reimbursement and regulatory perimeters. Must be able to explain technical and complex information in such a way that patients and family can understand. Strong interpersonal skills that facilitate the gathering of information necessary for assessing the patient’s needs and the range of treatment and care necessary.