Administrative Manager Medical Management; JR

Introduction
To heal, to teach, to discover and to advance the health of the communities we serve.

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Ensure that patients receive quality care in the most cost-effective manner and at the appropriate level. Manage the Department's operations and activities, including discharge planning, utilization management, transition of care, and high-risk case management. Provides strategic and operational leadership for care management services, including Case Management, Social Work, and Care Transitions. Ensures optimum utilization of Social Work and RN Case Management Skills.

Collaborate across departments to align care coordination with organizational goals, especially Length of Stay (LOS) optimization and discharge efficiency. Responsible for achieving and promoting continuous quality improvement, optimal financial productivity, patient satisfaction, and other objectives identified by the Leadership Team. In collaboration with the Senior Director, this position is responsible for staff performance, establishing policies and procedures governing the program's operations, and achieving goals in accordance with all State and Federal Guidelines.

• Provides direct management to Staff. Develops program philosophy and operational goals consistent with the Organization’s Mission and Strategic Plan.
• Ensures program compliance with Joint Commission, State, and Federal Regulations related to Discharge Planning, Utilization Management, Transition of Care, and Continuum of Care.
• Creates and fosters positive customer relationships with patients, interdisciplinary teams, healthcare agencies, and the Network.
• Supports effective Customer Service Networks in collaboration with the team. Identifies growth opportunities.
• Develops and implements new services and/or programs. Interfaces and coordinates services with Admission, Finance, Managed Care, Medical Records, Home Care, Rehabilitative, and Risk Management.
• Ensures provisions of a seamless continuum of care.
• Ensure consistency in workflows, documentation, and discharge planning practices.
• Support appropriate level of care decisions (e.g., admission, observation, home-based care).

• Collaborate with the Senior Director to lead, mentor, and develop high a high-performing care management team.
• Promote professional development and succession planning across the care management structure.
• Foster a collaborative, inclusive, and accountable culture.
• Establishes and coordinates communication with all Utilization Regulatory Agencies.
• Oversees appeals, at the first level of appeal as appropriate, to maximize reimbursement.
• Reviews and edits Managed Care Contract Language relating to Utilization Management Issues.
• Fulfills all compliance responsibilities related to the position. Ensure compliance with CMS, Joint Commission, and all relevant regulatory requirements.

• Bachelor’s degree in nursing and a minimum of five years of job-related experience. A Master's degree in nursing or health management is desired but not required. MSW considered.
• Knowledge of community resources, agencies, and financial assistance programs, knowledge and/or experience in managed care.
• Ability to collaborate with multidisciplinary groups and staff at all levels, including community partners.
• Must possess comprehensive knowledge of the healthcare Industry, familiarity with government regulations, and possession of strategic planning skills.