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case management

Manager Care Management

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Cleveland ClinicAvon, MT
  • Utilizes clinical expertise and understanding of utilization review requirements, discharge planning process, and Medicare regulations.
  • Contributes to the goals of cost containment and quality care.
  • Provides safe and appropriate discharge plans, and minimizes the avoidable commercial payer denials.
  • Assists with hiring, orienting, evaluating and supervising performance of the care management and social work staff.
  • Arranges schedules, evaluate caseloads and makes daily assignments.
  • Evaluates and addresses educational needs of staff, conducts performance improvement management and issues corrective action as needed and ensures consistent applications of policies and compliance.
  • Provides input into the department budget, policies and procedures.
  • Assists in the development of department practices and procedures for utilization review and discharge planning, ensuring compliance with managed care contracts and Medicare regulations.
  • Analyzes productivity and other outcome measures to identify opportunities for continuous improvement.
  • Manages information systems to maximize the efficiency of discharge planning.
  • Develops and monitors routine data quality validation.
  • Acts as liaison with other review-related and discharge planning related functions and communicates with departments as necessary to ensure coordination of related processes and functions.
  • Establish relationships with post acute care providers.
  • Serves as a clinical subject matter expert for teams lead by other disciplines.
  • Other duties as assigned.
  • Candidate must meet either the Nursing or Social Work education requirements.
  • Registered Nurse: Bachelor of Science in Nursing (BSN) or Bachelor's in related field required.
  • Master's degree in nursing or related field preferred.
  • Social Work: Master's degree in Social Work accredited by the Council on Social Work Education.
  • For Registered Nurses: Current and valid license to practice as a Registered Nurse (RN) in the State of Ohio.
  • Professional certification as a Case Manager (CCM) required within one year of eligibility.
  • For Social Workers: Current Ohio Licensed Social Worker (LSW) required.
  • Within scope of job, requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
  • Must be able to work in a stressful environment.
  • Minimum three years of experience in utilization management, case management, or discharge planning and three years clinical experience required, with at least three years of experience in a hospital/health care setting, including experience with data collection and performance improvement activities preferred.
  • Previously supervisory experience in the field of care management or social work preferred.
  • Requires the ability to sit and be stationary for prolonged periods of time, normal or corrected vision and manual dexterity sufficient to perform work on a personal computer.
  • Requires the ability to walk to various locations throughout the Clinic and facilities.
  • Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects.
  • Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible.
  • Note: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.
  • Follows standard precautions using personal protective equipment as required.
  • The policy of Cleveland Clinic and its system hospitals (Cleveland Clinic) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment.
  • All offers of employment are followed by testing for controlled substance and nicotine.
  • Job offers will be rescinded for candidates for employment who test positive for nicotine.
  • Candidates for employment who are impacted by Cleveland Clinics Smoking Policy will be permitted to reapply for open positions after 90 days.
  • Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law.
  • Information provided on this application may be shared with any Cleveland Clinic facility.
  • Cleveland Clinic is pleased to be an equal employment employer: Women/Minorities/Veterans/Individuals with Disabilities.
  • If you are interested in applying for employment with Cleveland Clinic and need special assistance or an accommodation to complete our application process, please contact 216.448.
  • CCHR (2247) or email us.

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