Director of Case Management
2 months ago
Job Description
General Summary of Duties:
The Director of Case Management’s primary responsibilities include. The manager of case management is responsible and accountable for the implementation of the case management program at the hospital level. The components/roles of the inpatient case management program consist of the following: care facilitation, utilization management, case management, and discharge planning.
Supervises: Case Managers and Social Workers
Duties Include But Are Not Limited To:
- Provide leadership, education, and supervision for the day-to-day workflow of Case Managers and Social Workers.
- Monitor the Case Management Department’s documentation to ensure meets regulatory compliance.
- Collaborate with the Chief Financial Officer and Quality Department to develop and maintain quality improvement programs and trending of data (e.g., Avoidable Days, Readmissions).
- Maintain skills in case management and utilization review to allow for coverage of patient caseload to cover staffing needs of all areas of the hospital.
- Communicate with physicians concerning patient needs and aid with the development of appropriate plans of treatment and assist with level of care and bed placement assignments.
- Directly responsible for personnel actions including hiring, performance appraisals, employee schedules, and maintaining payroll records and time reports in KRONOS.
- Facilitate daily Multidisciplinary Rounds to provide collaboration with other disciplines to provide holistic patient care.
- Participate in discharge planning. Provides necessary education and resources to meet the discharge needs of individual patients and families.
- Active participant in the Utilization Review Committee and Revenue Recycle Committee.
- Promote efficient utilization of clinical resources.
- Promotes the appropriate amount of resources used based on patient acuity.
- Assures appropriate level of understanding, awareness, and compliance with all applicable Joint Commission, CMS, state, and local agency laws, internal/external regulations, guidelines, policies, procedures, and professional standards.
- Other duties as assigned.
Knowledge, Skills & Abilities:
- Working knowledge of payer requirements and discharge planning regulations that support the effect of the development of departmental policies, procedures, and standards.
- Working knowledge of Medicare managed care, inpatient, outpatient, and home health continuum, as well as utilization management, discharge planning, and case management.
- Ability to work collaboratively with healthcare professionals at all levels to achieve established goals and improve quality outcomes.
- Working knowledge of concepts associated with performance improvement.
- Self-motivated, proven communication skills, assertive, able to work independently and as a team member.
- Demonstrated effective working relationships with physicians.
Education:
- Graduate of a program of Registered Nursing.
- Bachelor of Science in Nursing degree preferred.
Experience:
- Minimum of two years of Case Management experience in utilization management, case management, discharge planning, or other cost/quality management programs.
- Two to three years of previous management experience is preferred with a minimum of two years’ experience in hospital-based nursing.
Certificate/License:
- Iowa Mandatory Reporter – Child and Dependent Adult Abuse Certificates
- Current RN license in the state of Iowa or a multistate license allowing to work in the state of Iowa
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