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Director of Case Management
3 months ago
The Director of Case Management, under the direction of the Chief Nursing Officer (CNO), serves as an interdisciplinary team member to coordinate the delivery of health care services leading to quality outcomes for the Hospital population and their families within the limits of the financial and social resources available. This person is the expert on issues related to utilization review and discharge planning. Current RN license in the state of Arkansas or Social Work license required. Minimum 5 years of acute clinical experience and a minimum of 3 years Clinical Case Management/Utilization Review experience (preferred). Ability to interact with a wide variety of individuals and handle several complex situations simultaneously. Maintains adequate physical and mental health to meet job performance standards. Theoretical knowledge of the nursing process, case management and continuity of care. Motivation for self-direction, integrity, and initiative. Attention to detail and follow-up. Ability to exercise supervisory skills and demonstrate leadership, creativity, and accountability.
Qualifications/Experience
Education:
Graduate of an accredited school of nursing or social work and possesses current AR Registered Nurse or Social Work license.
Experience:
Minimum 5 years of acute clinical experience and a minimum of 3 years Clinical Case Management/Utilization Review experience (preferred).
Other Skills:
Ability to interact with a wide variety of individuals and handle several complex situations simultaneously. Maintains adequate physical and mental health to meet job performance standards. Theoretical knowledge of the nursing process, case management and continuity of care. Motivation for self-direction, integrity, and initiative. Attention to detail and follow-up. Ability to exercise supervisory skills and demonstrate leadership, creativity, and accountability.
Licenses/Certificate:
Current RN license in the state of Arkansas or Social Work license required.
Essential Job Functions
To perform this job successfully, an individual must be able to perform each of the following Essential Duties satisfactorily. Reasonable Accommodations may be made to enable qualified individuals with disabilities to perform the Essential Duties of the position, provided it does not create undue hardship on SARH.
Observe professional ethics in maintaining confidential information acquired regarding person, financial, medical or employment of patients, families, and employees of SARH.
Must follow and enforce accepted safety practices for patients and SARH.
Must report hazards and initiate appropriate action.
Must participate in safety instructional programs.
Demonstrates support of the Hospital mission and vision statement.
Applies standard admission criteria to pre-screen admissions to determine necessity of admission and level of care and completed initial discharge planning assessment.
Supervises Case Manager.
Contributes to hiring and termination decisions, develops job descriptions and performance standards, schedules and monitors assignments and controls staffing levels to meet budgetary guidelines.
Provides counseling and training, addresses disciplinary problems and completes performance appraisals.
Maintains allocated budgets and completes variances.
Contributes to the development of a goal directed discharge plan of care that is prioritized and based on determined medical diagnosis,, problems and expected patient outcomes.
Collects and analyzes data in an ongoing manner, focusing on variances and outcomes management.
Implements discharge plan in collaboration with multi disciplinary team.
Evaluates effectiveness of care, systems, environment and patient’s progress toward outcomes.
Demonstrates appropriate application of computer, telephone, copy and fax machine.
Provides continuing education to Hospital employees and medical staff regarding case management, utilization review, and appropriate documentation for admission and continued stay criteria and DRG assignment
Supports patient/SO learning needs and implements appropriate measures.
Identifies barriers in learning and individualizes learning process to achieve the best patient outcome.
Records data relative to program evaluation.
Demonstrates awareness and sensitivity to rights of patients/SO.
Involves family/SO in plan of care and facilitates the patient through the continuum of care.
Works with patient and family to assure a timely and appropriate transfer to the next level of care - SNU, SNF and HH
Functions with an awareness of safety issues and reports unsafe issues appropriately.
Performs efficiently in emergency situations following established protocols, remaining calm, informing appropriate persons and documenting events.
Employees sound knowledge and actions in the care and decision making for designated patient populations.
Demonstrates self-directed learning and participates in continuing education for professional development.
Is aware of responsibility and accountability for own professional practice.
Works well with physicians, nurses, patients and families and in a team environment to manage the total function of the Case Management.
Strives to manage situations in a manner that reduces risk.
Maintains strict confidentiality regarding patients, employees and physicians.
Keeps updated and provides information on the work of the State Peer Review Board and HCFA rules and regulations and their scope of work.
Participates in activities related to clinical outcome data collection and participates in interdisciplinary team activities.
Uses quality improvement tools and strategies in problem-solving activities.
Reviews all potential critical care admissions for ER against SI/IS criteria.
Assists with determining appropriate care setting, i.e., ICU, telemetry, observation, inpatient, outpatient.
Analyzes utilization of health care resources through concurrent review, medical care evaluation studies, and identifies avoidable delays in Hospital services that contribute to misappropriation of Hospital resources.
Reports variances according to established care quality improvement process.
Conducts retrospective review of medical records as required, and works with external case managers by fax reviews or phone calls to case managers for continued stay, as necessary.
Monitors physician progress notes to ensure that adequate and timely documentation exists to support medical necessity and appropriateness of continued hospital stay.
Confers regularly with nursing staff, physicians and other ancillary departments about the medical necessity for admission or continued stay.
Uses effective communication methods and skills, using lines of authority correctly.
Facilitates the Utilization Management Committee meetings and activities.
Keeps current on the development of case management systems on a national level and recommends changes as needed to maintain a state-of-the-art concurrent case management system.
Differentiates culturally specific care into discharge plan and instructs other health care team members in complying with established cultural norms within a patient population.
Practices capable and effective problem identification and resolution skills as a method of sound decision making.
Participates in research activities and adopts research outcomes into own practice.
Coordinates with other hospital functions such as Health Information Management, business office and patient registration in matters of review decisions, discharge planning and fiscal communications.
Assists with regulatory compliance.
Participates in multi-discipline patient care conferences.
Coordinates efforts with business office to appeal any inappropriate denials.
Analyzes and implements JCAHO standards and functions relevant to coordination of care.
Forecasts, evaluates, recommends and implements policies and procedures related to the concurrent case management program including appropriate resource utilization and I. D. of avoidable days.
Works independently, efficiently, and recognizes priorities.
Maintains confidentiality of all patients, Hospital and physician related information.
Understands, upholds, and applies the Hospital’s philosophy
Able to relate and work with chronically ill and disabled patients of all ages, and with emotionally upset, and at times hostile people within the faculty.
Able to relate and work with various managed care representatives, defining the continuing need for medical treatment.
Other duties as assigned or delegated by a supervisor or management of the hospital.
This job description is a summary of the typical functions of the job, not an exhaustive or comprehensive list of all the possible job responsibilities, tasks, and duties you may be asked to perform when they are assigned.
