Nurse Manager - Case Management

Day Shift (Hours: 8a-4:30) No Weekends or Holiday

Wilmington, DE

ChristianaCare Wilmington Hospital is looking for an energetic, motivated Nurse Manager for our Case Management Department to manage the daily operations of longitudinal care management, precertification, appeals and denials for patients in the acute care setting.

Purpose: Daily contact with Physicians, Case Managers, Patient Financial Services, HIMS, and Managed Care Organizations. Frequent contact with the nursing department, ancillary departments, healthcare and referring community facilities and agencies. Regular communication with Directors, Physician Advisors, and Social Work.

Direction/Supervisor of others include:

Assigned supervisors, case manager, case management assistants and social workers.

Primary Responsibilities:

• Manages daily operations of the Care Management Team and Serves as an expert resource or staff and Christiana Care leadership related to care management functions.
• Evaluates and provides feedback/recommendation of information technology software that allows for comprehensive, longitudinal care management of an identified population of patients.
• Facilitates the development of care management guidelines, algorithms, and protocols.
• Develops and implements applicable care management processes, policies, and procedures.
• Prepares and reviews annual performance appraisals with employees.
• Develops systems and processes to effectively manage collaborative relationships with external third-party payers.
• Identifies areas of potential compliance risk and develops strategies to mitigate risk in collaboration with the Compliance Officer and staff.
• Maintains strong working relationship with compliance office and staff and actively engages in all compliance activities as requested.
• Assists in the preparation of the annual operating and capital budget.
• Develops processes for the accurate capture of data to maintain a care management dashboard reflective of key performance measures.
• Collaborates with Data Informatics team to analyze data and makes recommendations for program development/changes based on data analysis.
• Collaboration with the key internal stakeholders, develops and implements processes, policies & procedures to manage the transition of patients effectively and efficiently in accordance with state, federal and payer standards and regulations.
• Demonstrates knowledge of local, state, and federal reimbursement guidelines.
• Coordinates and facilitates dept meetings.
• Maintains a collaborative professional relationship with clinicians and administrative staff to develop, implement, and evaluate successful process outcomes.
• Collaborates with Physician Advisors as needed.

• Performs assigned work safely, adhering to established departmental safety rules and practices reports, in a timely manner, any unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, patients and visitors.
• Performs other duties as assigned.

Education, Experience & Leadership Requirements:

• Delaware RN License or compact state RN License
• Bachelor's degree required.
• Five years' experience in Case Management in an Acute Care hospital setting is preferred.
• Three years supervisory/management experience preferred.
• All candidates must be able to maintains required documented hours of relevant continuing education related to licensure requirements.

Physical Demands:

• Ability to ambulate with the hospital setting. Sitting, standing and lifting loads of 5-10 pounds
• Ability to utilize computer equipment.

Working Conditions:

• Frequent travel to multiple sites as needed. Occasional exposure to office materials. Normal office environment.

Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.