Assistant Nurse Manager-Case Management Full Time 40 ...

Job DetailsJob LocationBHI Bristol Hospital Main Campus - Bristol, CTPosition TypeFull TimeEducation Level4 Year DegreeJob Shift1st Shift (Days)DescriptionAt Bristol Hospital and Health Care, we begin each day caring today for your tomorrow. We have been an integral part of our community for the past 100 years. We are dedicated to providing the best possible care and service to our patients, residents and families. We are committed to provide compassionate, quality care at all times and to uphold our values of Communication, Accountability, Respect and Empathy (C.A.R.E.).We are Magnet ® and received the 2020 Press Ganey Leading Innovator award for our rapid adoption and implementation of healthcare solutions during the COVID-19 pandemic. Use your expertise, compassion, and kindness to transform the patient experience. Make a difference. Make Bristol Hospital and Health Care your choice.The Assistant Nurse Manager of Case Management uses evidence-based skills to support the delivery of effective and efficient patient care. Case Manager Nurses address patient needs from both a physiological and economic perspective while retaining overall accountability for both. The Assistant Nurse Manager of Case Management is a hands-on role which oversees both Utilization Management and Transitional Care Management for Patients currently receiving care at our Hospital. In this role the Assistant Nurse Manager will partner with members of the health care team including Social Workers to assess patients and implement an appropriate plan of care. Additionally, this role is responsible for the successful interpretation of nationally recognized criteria sets to support medical necessity for both admissions, and continued stay. Finally, along with the patient, family, and health care team, this role ensures that a safe and effective discharge plan has been created. Essential Duties and Responsibilities:Directly manages the day to day operations in the case management department.Provides direct management to the department staff, manages scheduling, and oversees the orientation of new hires. Evaluates and optimizes patient satisfaction with discharge planning functions. Attempts to resolve conflicts related to discharge planning with staff, patients/families, external agencies and payers.Assist the physician advisors in writing appeal letters to Insurance CompaniesWorks with the Revenue Cycle team to minimize Insurance denials.Works with Insurance companies and the Physician Advisor to establish and communicate inpatient care severity of illness and intensity of service.Provides support and guidance over utilization management including assisting the Physicians/Surgeons, APRN's, and PA's with level of care determinations. Maintains department metrics and audits. Provide updates to their corresponding committee or administrator.Education/Experience RequirementsMinimum of 3 years of Case Management, discharge planning and/or utilization review experience.Licensed as a Registered Nurse in the State of Connecticut.BSN or working toward BSN.Case Management Certification strongly preferred.Skills/KnowledgeStrong interpersonal, communication, and negotiation skills.Ability to form positive, collaborative relationships with hospital staff, patients and families.Ability to effectively negotiate with internal and external providers of patient care servicesAnalytical abilities to assist in obtaining solutions to problemsAble to work independently and prioritize work.Has familiarity with nationally recognized criteria sets including Interqual and Milliman MCG.Able to manage multiple priorities.Basic knowledge of computers and clinical applications.Ability to problem solve in a proactive, creative manner using sound judgment based on factual information and clinical knowledge.Communicate in a clear, concise, and logical manner in both oral and written presentationsThe preferred candidate:Has 5-7 years of Case Management / Utilization Management with progressively responsible experienceExposure to Social Work, Clinical Documentation and Utilization Review in addition to hands on Case Management experience.Has implemented processes and work on process improvements with demonstrable resultsIs metrics focused and a champion of process improvementIs a strong coach and mentor with good listening skillsIs able to establish credibility and gain the respect of his/her team as well as senior managementIs a decision maker that can deliver a roadmap and hold his/her team accountableEmpowers his/her team to solve problems and come up with solutionsPartners with operations for creative problem solving and goal settingHas strong organizational skillsStrong familiarity with acute care case management regulations.QualificationsEducational / Minimum Requirements:BSN degree (or active work toward BSN) required. Master's degree is preferred.State/Federal MandatedRN Licensure RequiredBristol Hospital Mandated Educational Requirements:General orientation at time of hire. Fire/Safety/Infection control annually. Other programs as required by The Hospital, JCAHO, DPH, OSHA, and other credentialing organizations.Work Environment: Office and Hospital setting. This is not a remote role. DisclaimerThe above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

Created: 2025-03-12