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Director of Care Management

2 months ago

Crown Point, United States NeuroPsychiatric Hospitals Full time

About Us:

HEALING THE BODY AND MIND.

Founded fifteen (15) years ago, NeuroPsychiatric Hospitals is the largest hospital system in the nation providing care to patients with both neurological and medical needs. We are unique in that we serve a population which others have been previously been unable to, largely due the patients underlying medial issues. Our facilities maintain an inter-disciplinary focus using a multi-specialty approach for both neuropsychiatric and complex medical care issues. This proven approach provides unrivaled quality care for all of our patients. We have multiple locations throughout the United States and are continuing to add locations to ensure better access to our unique model of care.

Overview:

NeuroPsychiatric Hospitals is looking for a Director of Care Management at our Crown Point location. NPH is the national leader in providing medical and neurobehavioral care to patients in acute psychiatric distress. You will be joining a team of rock star staff who provide exceptional, patient-centered care and understand our patients are always our number one priority The Director of Care Management for Neuro Behavioral Hospital is responsible for compliance with CMS Conditions of Participation regarding Utilization Review for the hospital system. The purpose of this position is to coordinate patients services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams. Address the entire episode of illness through the use of care management plans, pathways and protocols. Ensure that the hospital is reimbursed appropriately, decrease LOS and denials.

Benefits of joining NPH as a Vice President of Care Management

  • Competitive pay rates
  • Medical, Dental, and Vision Insurance
  • NPH 401(k) plan with up to 4% Company match
  • Employee Assistance Program (EAP) Programs
  • Generous PTO and Time Off Policy
  • Special tuition offers through Capella University
  • Work/life balance with great professional growth opportunities
  • Employee Discounts through LifeMart
Responsibilities:
  • Promote Quality Care: Ensure efficient use of hospital resources by reviewing medical necessity, length of stay, promptness of service, consultations, and discharge planning.
  • Identify and Improve Problematic DRGs: Isolate problematic Diagnosis Related Groups (DRGs), diagnoses, or procedures, and suggest improvements.
  • Coordinate Utilization Review and Case Management: Lead the hospital's Utilization Review and Case Management program.
  • Care Guidelines: Utilize InterQual and Milliman Care Guidelines.
  • Leadership and Coordination: Coordinate services, promote effective care utilization, and monitor healthcare resources.
  • Review Patient Charts: Verify medical necessity and severity of illness, ensuring compliance with Care Guidelines and regulatory standards.
  • Collaborate for Reimbursement: Work with Medical Records, Finance, and physicians to ensure accurate coding and documentation for appropriate reimbursement.
  • Address Entire Episode of Illness: Use critical pathways, protocols, and care management plans to manage the entire episode of illness.
  • Financial Outcomes: Optimize financial outcomes by decreasing resource utilization and length of stay.
  • Documentation Review: Ensure accurate documentation of patient progress and take action when documentation is lacking.
  • Collaborative Work: Work with staff nurses, physicians, and other healthcare providers to achieve patient outcomes within length of stay guidelines.
  • Resource Management: Develop strategies for efficient resource management and update staff on policies.
  • Financial Goals: Develop and monitor annual financial goals for designated case types.
  • Regulatory Knowledge: Maintain current knowledge of regulatory and accreditation standards.
  • Initiative Development: Implement initiatives to reduce length of stay, improve patient care quality, and manage resources effectively.
  • Research Utilization: Use research to identify problems, conduct patient care research, and implement findings.
  • Team Meetings: Conduct meetings with healthcare providers to address case management and utilization review issues.
  • Communication: Communicate with physicians, family members, and healthcare providers on case management issues.
  • Healthcare Team Coordination: Coordinate healthcare team efforts to improve patient care outcomes within a specified timeframe.
  • Discharge Information: Ensure completeness and reliability of patient discharge information.
  • Discharge Planning: Identify and report discharge-planning problems.
  • Problem Investigation: Investigate and define problems related to case management and utilization review.
  • Education Resource: Serve as a resource for education and communication regarding utilization review and case management.
  • Orientation on Policies: Provide orientation on changes in policies to maximize reimbursement and care quality.
  • Data Reporting: Prepare reports for denial management and utilization review.
  • Representation: Represent case management in communities, councils, and work groups.
  • Meeting Participation: Attend meetings for committees on utilization management and performance improvement.
  • Information Dissemination: Disseminate information on trends and research in case management.
  • Certification Support: Support certification of patients length of stay and inform insurance companies.
  • Guideline Implementation: Implement guidelines for patient discharge information completeness.
  • Regulatory Compliance: Keep updated on federal, state, and hospital regulations.
  • Compliance Standards: Adhere to NPHs Corporate Compliance Policy, Code of Conduct, and Conflict of Interest Policy.
Qualifications:
  • Certificate in Nursing required if a nurse or Masters in Behavioral Health.
  • Five years' experience in hospital administrative position with responsibility for administrative supervision and board of trustees contact preferred.
  • Excellent verbal communication skills necessary in order to instruct and comfort patients and their families.
  • Maintain effective contacts with a variety of Hospital Personnel.
  • Must demonstrate knowledge and skills necessary to provide care appropriate to the age of the patient served.