We have an exciting leadership opportunity for a Care Manager/Utilization Manager for our Case Management Team. This position will manage people and the daily operations of longitudinal care management, precertification, utilization management, appeals and denials for at risk populations within Christiana Care Health System.
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.
Manages daily operations of the Care Management Team.
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 the annual operating and capital budget
Develops processes for the accurate capture of data in order 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.
In collaboration with the key internal stakeholders, develops and implements processes, policies, and procedures to effectively and efficiently manage the transition of patients in accordance with state, federal and payer standards and regulations.
Demonstrates knowledge of local, state, and federal reimbursement guidelines.
Serves as an expert resource for staff and Christiana Care leadership related to care management functions.
Coordinates and facilitates department meetings.
Maintains a collaborative professional relationship with clinicians and administrative staff necessary to develop, implement, and evaluate successful process outcomes.
Collaborates with program medical director as needed.
Education and Experience Requirements:
Registered Nurse Licensure.
Five years' experience in both Utilization Management and Case Management
Three years' supervisory/management experience
Experience with third party contacting.
Knowledge of URAC, HEDIS and/or NCQA standards, outcome analysis, project management and data systems required.
CEUs must be maintained related to licensure requirements.
Internal Number: 47505BR
About Christiana Care Health System
Christiana Care Health System is headquartered in Wilmington, Delaware and is one of the country's largest health care providers, ranking 21st in the nation for hospital admissions. Christiana Care is proudly a Nurse Magnet recognized institution. Christiana Care Health System is also one of the largest health care providers in the mid-Atlantic region, serving all of Delaware and portions of seven counties bordering the state in Pennsylvania, Maryland and New Jersey. A not-for-profit, non-sectarian health system, Christiana Care includes two hospitals with more than 1,100 patient beds, and is a major teaching hospital with two campuses. Christiana Care is continually recognized for excellence on a regional and national level. Our role in the community is expressed in the Christiana Care Way: "We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value."Christiana Care is a great place to work because we value diversity and recognize it to be a core part of our success. Because of the diversity of our employees, affiliated health professionals and volunteers, we are... positioned to meet the unique needs of our patients and community. We acknowledge and celebrate the uniqueness and talent of each employee. Because of our talented workforce we are able to provide a quality healthcare experience to our patients and community. We strive to create an inclusive environment in which individual diversity can be leveraged and thrive. 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.