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Director of Case Management

4 months ago

Humble, United States Memorial Hermann Health System Full time
At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

The Director of Case Management is responsible and accountable for the implementation of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, Utilization Management, Case Management and Discharge Planning.

The Director is responsible for developing systems and processes for care/utilization management and discharge planning at the hospital level. In addition, the Director may be responsible for managing the department's activities related to discharge planning and clinical quality improvement. The Director evaluates and ensures that hospital resources are used appropriately and effectively. The Director oversees the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement. The Director promotes interdisciplinary collaboration, fosters teamwork and champions service excellence.Job Description

Minimum Qualifications

Education: Bachelors of Nursing (BSN) or Masters Social Work (MSW); Masters degree preferred

Licenses/Certifications:
  • Current and valid license to practice as a Registered Nurse in the state of Texas or
  • Current and valid Texas license as a Master's Social Worker (LMSW), required
  • LCSW preferred and Certified Case Manager (CCM), Accredited Case Manager (ACM) or
  • Fellowship of the American Academy of Case Management (FAACM), required


Experience / Knowledge / Skills:
  • Minimum five (5) years experience in utilization management, case management, discharge planning or other cost/quality management program
  • Three (3) years of experience in hospital-based nursing or social work preferred
  • 5 years supervisory experience
  • Self-motivated, proven communication skills, assertive
  • Background in business planning, and targeted outcomes
  • Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management
  • Working knowledge of the concepts associated with Performance Improvement
  • Demonstrated effective working relationship with physicians
  • Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes
  • Effective oral and written communication skills


Principal Accountabilities
  • Plans, directs and supervises all aspects of the local level program.
  • Facilitates growth and development of the case management program consistent with enterprise wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed.
  • Responsible for approving and managing the day to day local level operational budget.
  • Assures that revenue, expenses, contribution margin and FTE's meet or exceed budget.
  • Prepares and submits budget and related reports.
  • Forecasts and accurately projects expenses.
  • Takes corrective action to address negative variances.
  • Identifies and proposes capital budget items appropriately.
  • Identifies and achieves optimal targeted financial outcomes via the inpatient case management process.
  • Responsible for departmental personnel functions (hiring, firing, etc.) in conjunction with the Executive Director of Medical Management.
  • Writes and conducts annual and interim performance appraisal reviews for the professional and non-professional staff in department.
  • Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospitalists, community care managers, nurses, community resources, etc.)
  • Responsible for leading a high performance team of "system thinkers" who incorporate leadership principles and vision in performing the functions of case management.
  • Uses data to drive decisions, plan, and implement performance improvement strategies for case management.
  • Oversees the education of physicians, managers, staff, patients and families related to the case management process at the local level.
  • Participates in this evolutionary process by constantly identify future needs of current customers and/or identifying potential new customers.
  • Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
  • Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann's service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
  • Other duties as assigned.