Manager, Case Management
PI Operations Manager serves a key role in in the rollout, implementation and scaling of the standard functions of Utilization Review and Appeals process. The goals are to engage with CM UR RN’s, DCM’s at Hospitals and physicians and key hospital stakeholders (1) through data review to reduce the clinical denials, care variation in cost and utilization of care delivery, while at the same time, improving quality and patient outcomes and (2) to work with hospitals to use data and quality reviews from documentation of care to identify monitor and track performance improvement opportunities.
- The PI Operations Manager position will have key responsibility in implementing a sustainable standard approach across Steward for UR and Appeals process and meet key metrics in declining clinical denials.
- The PI Operation Manager will also focus at the hospital with the UR Committee and Physicians to activate the UR process with and understanding of daily workflow and trending data.
- The focus will be on educating the team and Physicians with CDI and CM and other partners to identify documentation elements to demonstrate care variances to focus on.
- Work with analytics and dashboards to distribute reports and presentations as needed to educate or communicate progress and areas to focus on for process improvements.
- Successfully complete special projects or assignments as required in accordance with defined goals and objectives.
- Be a key communication point with internal partners and stakeholders. Hospital Leadership, Central Business Office, Steward Physician Group, Steward Health Care Network, Corporate, IT.
- Ability to work competently with computer-based programs and manager project plans and follow up to resolve any trends that are not favorable
- Develop overarching narrative for performance; develop concise presentation for Executive Leadership
- Ability to teach and present material at hospitals with leaders
- Ability to manage the data in manageable format for communication with the key stakeholder
- Adaptability to frequent change and good organizational skills are required. Must communicate effectively in English, or language prominently at hospital assigned, verbally and in writing.
- Working knowledge of analytics tools to utilize for trending data
- Ability to work in a stressful, fast-paced environment.
- Proficient in training individuals at all levels of the organization as well as physicians
- Demonstrate strong project management skills with the ability to manage multiple high-profile projects at the same time.
- Experience managing a team in a fast paced, time-sensitive environment, demonstrating the ability to motivate to continuously improve their performance with successful outcomes.
- Possess the ability to make independent decisions when circumstances warrant such action, deal tactfully, and seek out new methods and principles and be willing to incorporate them into existing practices.
- Possess ability to educate, inform, advocate, promote and facilitate health care options, and demonstrate the willingness to work harmoniously with a team approach.
- Must have patience, tact, cheerful disposition and enthusiasm and be able to relate to and work with ill, disabled, elderly, emotionally upset residents/patients and their families.
- Must be able to read, write and speak the English language
- Strong computer skills, Microsoft Products, PowerPoint,
- Able to be educated on use of Meditech, Allscripts, Cerner
- Must want to travel when needed -less than 75 % of time and in office or remote as needed
- Bachelors minimum or Masters Advanced degree in health administration, or equivalent education and experience preferred
- Registered Nurse preferred
- Minimum of five years of progressive healthcare experience in managing processes and workplans with measurement to key performance metrics. Expertise with analytical tools to manage Dashboards
- Performance scheduling, orientation, and training
- Provides effective direction, guidance, and leadership over the staff for effective teamwork and motivation and fosters the effective integration of efforts with system-wide initiatives
- demonstrates Standards of Respect and contributes to creating and maintaining an environment of professionalism, respect, tolerance, civility and acceptance toward all employees, patients and visitors.
- Integrates diversity into departmental objectives, such as hiring, promotions, training, vendor selections, etc.
- performance improvement initiatives and demonstrates the use of quality improvement in daily operations.