Manager, Care Management

Summary

The Manager of Care Management provides operational leadership and oversight of the Care Management Department, ensuring the delivery of safe, efficient, and patient-centered care. This position focuses on the day-to-day management of discharge planning, care coordination, and case management staff, while supporting compliance with CMS Conditions of Participation (CoPs), DNV accreditation standards, and ACMA best practices.

The Manager collaborates with the Director of Care Management, Nursing, Medical Staff, Utilization Review, and other operational leaders to support patient flow, discharge readiness, and barrier resolution, ensuring departmental goals and performance metrics are met.

Leadership and Oversight

• Provides day-to-day leadership for Care Management staff.
• Implements departmental policies, procedures, and workflows to ensure efficient patient care and safe transitions.
• Oversees staff assignments, scheduling, and resource allocation to meet departmental and organizational goals.
• Monitors length of stay, discharge delays, avoidable days, and readmissions, escalating issues to the Director as needed.
• Supports departmental readiness for internal and external audits, quality reviews, and compliance monitoring.

Staff Development and Performance

• Recruits, trains, and evaluates Care Management team members; conducts performance appraisals and corrective actions as appropriate.
• Supervises and evaluates Care Management staff; provides coaching, feedback, and corrective action as needed.
• Ensures orientation, competency validation, and ongoing education for staff in discharge planning, care coordination, and patient advocacy.
• Promotes a culture of professionalism, accountability, and collaboration across the Care Management team.
• Supports the Director in implementing continuous staff development programs aligned with CMS, DNV, payer, and ACMA standards.

Collaboration and Communication

• Coordinates daily discharge planning rounds and barrier resolution activities, escalating complex or high-risk cases to the Director.
• Communicates effectively with Nursing, Medical Staff, Therapy, Ancillary Departments, and post-acute providers to facilitate timely transitions of care.
• Provides education and guidance to staff and other hospital departments on case management processes, regulatory requirements, and community resources.
• Maintains accurate and timely documentation of case management activities in hospital software systems.

Operational and Quality Improvement Support

• Monitors key departmental metrics and prepares reports for the Director of Care Management as requested.
• Assists in implementing process improvement initiatives to enhance patient flow, reduce readmissions, and improve patient satisfaction.
• Ensures staff compliance with CMS CoPs, DNV standards, and hospital policies for care management documentation and processes.

 Supervisory Responsibilities

Reports to: Director of Care Management
Supervises: Registered Nurse and Social Work Case Managers

Responsibilities: Day-to-day operations of the Care Management Department, staff supervision, and process execution.

Education and Experience

• Bachelor of Science in Nursing (BSN); Master’s preferred.
• Minimum of three (3) years of acute care case management experience required.
• At least one (1) year of leadership experience preferred, including supervisory, lead, or senior-level responsibilities in a healthcare or case management setting.

Licenses and Certifications

• Active Registered Nurse (RN) license in the Commonwealth of Virginia required.
• Certification as an Accredited Case Manager (ACM) or Certified Case Manager (CCM) required.