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Manager of Case Management

2 months ago

Waterbury, United States Waterbury Hospital Full time
SCOPE OF POSITION:

Responsible for the leadership of the Case Management Department within Waterbury Hospital. Responsible for implementing case management/continuing care objectives and utilization review/clinical resource management initiatives to ensure compliance with all relevant statutes and standards. Responsible for developing an infrastructure for assessing, determining, and coordinating the discharge needs of patients to facilitate optimum outcomes and throughput. In collaboration with providers ensures patients are placed in the clinically appropriate level of care via established algorithms and protocols. Develops and monitors key performance indicators. Contributes to hospital forums continually reviews case management processes for the effective flow of patients through the hospital. Provides operational supervision of the RN Case Managers, ED Nurse Case Manager, and Utilization Review Nurses . Coordinates and supports ongoing problem solving. Establishes tools, processes, and systems to support the Case Management process and optimize outcomes.

RESPONSIBILITIES:

  • With Regional Director of Case Management, establishes, implements and evaluates a strategic plan for the department that takes into account internal and external factors.
  • Effectively communicates the plan throughout the organization.
  • Creates data priorities and report formats that display key performance indicators.
  • Reviews the findings with the Regional Director
  • Continually provides feedback to the department staff regarding Case Management metrics
  • Identifies appropriate staffing levels, assignments, and deployment for the department.
  • Establishes processes and policies that adhere to Joint Commission standards as well as CMS Conditions of Participation and other regulations.
  • Collaborates with hospital Compliance Officer to ensure developed processes and policies meet compliance standards.
  • Co-chairs a Utilization Management Committee participates in the selection of standing agenda items and provides reports and data to be reviewed.
  • Collaborates with multidisciplinary leaders across the organization to facilitate participation in multidisciplinary care planning, care delivery, and discharge planning.
  • Develops and maintains effective relationships with hospital department heads, nursing managers and administrators, and the administrative staff.
  • Establishes effective relationships with external agencies providing services to the organization (such as vendors, care providers, post-acute providers, physician organization, community agencies etc.).
  • Evaluates and optimizes patient satisfaction with discharge planning functions.
  • Directs utilization review activities for the hospital, interfacing with external payers and review companies to determine appropriate medical necessity of admissions and continued hospitalization.
  • Resolves conflicts related to discharge planning with patients/families, external agencies and payers.
  • Provides leadership to multidisciplinary groups as organized by the facility.
  • On an annual basis, collaborates with Regional Director to develop measurable, reasonable and market-oriented goals for the department that reflect those of the sponsoring organization and the department.
  • Regional Director, establishes policies, procedures and protocols for departmental functions.
  • Ensures that the Utilization Management process and policies are current.
  • Ensures that the Discharge Planning process and policies are current.
  • Creates processes to anticipate and address specific situations within the department, including long stay patients, post-acute resource referral lists, denials, and termination of benefits.
  • Identifies improvement opportunities within the department and at the system level and creates strategies to address them.
  • Creates a system for initial and ongoing competency and development of staff.
  • Provides timely and effective departmental and organizational communication.
REQUIREMENTS:
  • Minimum of 3-5 years of experience in: Case Management and utilization review experience preferred. Prior experience in a management or administrative position preferred.
  • Registered Nurse licensed in the state.
  • Master of Science in Nursing (or another related healthcare Master's degree) preferred.
  • Knowledge of payer requirements and discharge planning regulations that support the effect development of departmental policies, procedures and standards.
  • Demonstrated ability to: Establish the goals, vision, and overall direction of a department; create and implement departmental standards, systems, staffing plan and processes; analyze issues and create and effective plan to address them; critically and comprehensively evaluate the department's outcomes; identify, collect and analyze data related to the internal and external environment as well as departmental functioning; and develop and educate staff.
  • Demonstrated ability to communicate verbally and in writing to internal and external constituencies.
  • Ability to establish priorities, meet deadlines, and develop and manage the department's productivity standard in the management of work assignments.
  • Ability to form positive, collaborative relationships with members of the executive team, hospital staff, post-acute providers and payers.
  • Ability to problem solve in a proactive, creative manner, using sound judgment based on factual information and clinical knowledge.
  • Ability to effectively negotiate with internal and external service providers.
  • Knowledge of external requirements that impact the department, such as JC and CT Department of Health.
  • Knowledge of information systems to support the evaluation of current capacity as well as future needs.


THE ABOVE DESCRIPTION COVERS THE MOST SIGNIFICANT DUTIES PERFORMED BUT DOES NOT EXCLUDE OTHER OCCASIONAL WORK ASSIGNMENTS NOT MENTIONED, THE INCLUSION OF WHICH WOULD BE IN CONFORMITY WITH THE FACTOR DEGREES ASSIGNED TO THIS JOB.