Award-winning hospital seeks a dynamic registered nurse to lead our Care Management department in providing the highest quality care in our state-of-the-art facility. This position will:
• Provide leadership to the Care Management Department, including case management, transition of care, utilization review, and social services for the organization
• Responsible for providing leadership to the hospital house supervisors
• Bachelor’s Degree in Nursing required
• MSN or master’s degree in Business Administration, or applicable Master’s degree in a health care category preferred.
Certifications and Licenses:
• State of Wisconsin Registered Nurse license required upon hire
• Case Manager Certification or Case Management Administrator Certification or Certified Nurse Manager Leader within 18 months of hire and achieved within 2 years of hire
• Case Manager Certification or Case Management Administrator Certification or Certified Nurse Manager Leader preferred upon hire
• 3-5 years clinical experience in a surgery setting
• Minimum of 3 years of experience in nursing management required
Position Technical Responsibilities:
Supervision: Direct supervision of the Care Management staff including: Case Management, Social Work, Utilization Review, and House Supervisor.
Budgeting: Develop and work within annual operating budgets, focus on ensuring appropriate resource utilization and documentation for effective cost containment and performance improvement.
Counsel: Provides guidance and advice to senior leadership on changes in medical management, utilization of services, and patient-centered growth opportunities. Partner with senior leaders to implement a dynamic and innovative case management plan to position the organization for the future.
Responsibilities: Accountable for overseeing patient care as it relates to the management of the patient along the continuum of care, utilization activities, disease management appropriateness, discharge planning, case management, care coordination.
1. Leads organization wide strategic initiatives to reduce readmissions and improve care transitions.
2. Facilitate and oversee medical necessity review of admissions using evidence-based criteria, to promote effective utilization of services, standard of care, and adherence to CMS and third-party payer requirements.
3. Promote interdisciplinary collaboration both internally and externally, fosters team work and champion service excellence.
4. Provide education and consult to physicians, medical staff, and senior leadership on case management, transitions of care, and utilization of services to promote a continuous improvement environment.
5. Develops and oversees all programs to proactively manage patients to prevent unnecessary admissions and readmissions, coordinate discharge planning efforts and monitor pharmacy and radiology utilization.
6. Monitor, analyze, and report key metrics to ensure performance on financial, service, and quality metrics. Ensure compliance with all quality initiatives.
7. Maintain knowledge of regulatory requirements, accrediting body standards, Wisconsin Administrative Codes, and CMS Conditions of Participation relating to Utilization Review and Discharge Planning. Ensures compliance with these standards.
1. Demonstrate leadership skills in motivation, change management, conflict resolution, and written and oral communication.
2. Oversee utilization of staff resources to maintain appropriate coverage of service throughout all areas of the hospital.
3. Oversee and promote professional growth of self and staff. Facilitate educational opportunities that enhance skills and meet professional licensure requirements.
4. Directly responsible for hiring, orienting, training, ongoing education, evaluation and supervision of all department staff. Implement retention strategies.
5. Facilitate inter/intradepartmental-working relationships and hold regular meetings to keep staff informed about decisions and events that affects them.
Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. Facilitates the hospital Utilization Review program, in compliance with CMS and other accrediting body standards.
Prepare and oversee department budget. Ensure that fiscal responsibility is exercised in all financial decisions. Analyze budget reports monthly to identify variances. Demonstrate strong general business knowledge and skills.
1. Facilitate and oversee the development of a patient-centered Case Management program.
2. Serves as a resource and consultant to all other areas of the organization.
3. Educate medical and hospital staff on CMS and third party payer requirements and limitations as they affect a patient's plan of care. Determine validity and appropriateness of non-payment of claims by Medicare and third party payers.
4. Facilitate the following Committees: Utilization Review, Discharge Planning/Re-Admissions, and Daily PCC. Chair or serve on committees throughout the organization and community as requested.
1. Develop and direct the expansion of services that provide continuity of care post hospital stay.
2. Create, support and champion new ideas, innovative thinking and reasonable risk taking.
3. Serve as community liaison and content expert to external audiences (e.g., state and national organizations, peer groups, county organizations) and personally represent SPH as a speaker, consultant and/or group participant.
4. Establish and maintain formal and informal networks and relationships with key stakeholders and providers both inside and outside the organization. Serve as ambassador for SPH.
5. Serve as key contact expert for all utilization management and transitions of care inquiries. Provide information and written statements as requested.
Required Knowledge, Skills, and Abilities:
(This is not an all-inclusive list of knowledge, skills, and abilities. For further information please reach out to our human resource department.)
• Thorough knowledge of, and commitment to, the hospital's philosophy on Service and Performance Excellence.
• Must possess strong knowledge of medical terminology, anatomy, electronic medical records, and computer applications and have the ability to utilize government-sponsored web sites independently to generate reports, download files, research rules.
• Ability to work independently with a high degree of accuracy and attention to detail.
• Skills in problem solving, planning, setting priorities, making decisions, and communicating clearly both verbally and in writing, to patients, coworkers, third party payers, physicians and agencies.
• Errors may result in confusion or financial loss to patients or the Hospital.
• Skills in understanding, explaining, teaching, and motivating people are vital.
• Position requires courtesy, tact, excellent human relations skills, and a team member able to keep sensitive information about patients and others strictly confidential
• Full time position consisting of 80 hours in a bi-weekly pay peroid (1.0 FTE)
o Weekly schedule: Monday through Friday, primarily working hours between 7:00 a.m. and 5:30 p.m.
• Competitive health and dental insurance options
• Flexible paid time off to balance work and life
• Retirement plan with immediate vesting and employer match
• Free State-of-the-art fitness facility membership
• Generous tuition reimbursement
• Employer provided life and disability insurance
Sauk Prairie Healthcare is a nationally-recognized system of primary and specialty services headquartered in a new state-of-the-art facility. We set the standard for service excellence, patient safety, and overall quality.
Interested in an extraordinary career? Click the link to apply.