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Location: US:WI:MILWAUKEE at our FROEDTERT HOSPITAL facility.
This job is HYBRID.
Shift: Shift 1
The Manager, Care Management/Care Transitions oversees the day-to-day operations and performance management of RN Case Managers, Utilization Review Case Managers, Denials Coordinators, and Case Management Specialist staff for the Care Management & Care Transitions department. Plans, organizes, evaluates and manages hospital acute care case management, discharge planning, and utilization management functions including patient assessment, discharge care planning, counseling, transition management, admission management, medical necessity, and patient outcome evaluation. Performs all functions in accordance with all federal, state, and local regulations and scopes of practice for the nursing profession. Serves as an expert resource on laws, policies, and operational procedures. Analyzes available data to measure individual and department performance, clinical program performance, department processes, and compliance. Works in conjunction with the Director, Care Management/Care Transitions on a variety of critical tasks including the management of one or more focused clinical initiatives. Develops, analyzes, updates, and monitors metrics for care management initiatives. Assists in budget development and maintenance. Plays an integral role in representing the company externally in presentations with key provider and member groups and provides oversight to those provider groups that are delegated for clinical functions. Develops and maintains cooperative working relationships with other hospital departments and outside agencies to coordinate provision of medical care and transitions through the care continuum. Develops and implements policies and procedures that integrate State and federal regulations to ensure compliance with government agency requirements. Other duties as assigned.
Five years of related experience within care management & care transitions with progressively more responsible work experience necessary to gain full knowledge of care management objectives and practices and acquire administrative skills necessary to lead and direct departmental personnel is required. In addition to minimum experience requirements, three years of leadership experience in a hospital setting is strongly preferred.
Degree in Nursing (Baccalaureate or Graduate) is required. Graduate degree in Nursing or Related Field is preferred.
Acute Care RN case management experience and/or utilization management experience using MCG is strongly desired.
SPECIAL SKILLS DESCRIPTION:
Demonstrated commitment to excellent customer service. Understands health care delivery and what is required for an integrated care continuum for diverse patient populations. Excellent interpersonal skills required to communicate and collaborate productively and professionally with both internal and external customers. Proven process improvement skills. Exceptional analytical skills and critical-thinking abilities. Ability to concentrate and focus attention on details for up to 80% of work time when interviewing patients, preparing discharge plans, and performing management functions, such as budgeting, analyzing, scheduling, and statistical reporting.
Requires current state of Wisconsin Registered Nurse License or Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact). Accredited Case Manager (ACM) certification per the ACMA (American Case Management Association) is required within one year of hire or transfer.
Perks & Benefits at Froedtert Health
Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following:
- Paid time off
- Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities
- Academic Partnership with the Medical College of Wisconsin
- Referral bonuses
- Retirement plan – 403b
- Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
- Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available
The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin’s only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.
We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.