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Head of Patient Care Coordination
2 months ago
Position Overview
The Clinical Case Management Director, reporting to the Chief Nursing Officer (CNO), plays a vital role as part of an interdisciplinary team dedicated to optimizing healthcare delivery, ensuring quality outcomes for patients and their families while adhering to available financial and social resources.
Qualifications and Experience
Education:
Must be a graduate of an accredited nursing or social work program and hold a current AR Registered Nurse or Social Work license.
Experience:
Minimum of 5 years in acute clinical settings and at least 3 years in Clinical Case Management or Utilization Review (preferred).
Key Skills:
Ability to effectively engage with a variety of individuals and manage several complex situations simultaneously. Must maintain adequate physical and mental health to meet job performance standards. Strong theoretical knowledge of the nursing process, case management, and continuity of care is required. The candidate should exhibit self-direction, integrity, and initiative, along with meticulous attention to detail and follow-up. Demonstrated leadership skills and accountability are essential.
Licenses/Certificates:
Current RN license in Arkansas or Social Work license is required.
Core Responsibilities
To successfully fulfill this role, the individual must be capable of performing the following essential duties effectively.
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 South Arkansas Regional Hospital.
Maintain professional ethics by safeguarding confidential information related to patients, families, and employees.
Report hazards and take appropriate action.
Participate in safety training programs.
Support the hospital's mission and vision.
Apply standard admission criteria to pre-screen admissions to determine the necessity of admission and the appropriate level of care, and conduct initial discharge planning assessments.
Contribute to hiring and termination decisions, develop job descriptions and performance standards, schedule and monitor assignments, and manage staffing levels to meet budgetary guidelines.
Manage allocated budgets and address variances.
Assist in developing a goal-oriented discharge plan of care that is prioritized based on medical diagnoses, problems, and expected patient outcomes.
Implement discharge plans in collaboration with a multidisciplinary team.
Evaluate the effectiveness of care, systems, environment, and patient progress toward outcomes.
Demonstrate proficiency in using computers, telephones, copiers, and fax machines.
Provide ongoing education to hospital staff and medical personnel regarding case management, utilization review, and proper documentation for admission and continued stay criteria.
Support patient and significant other learning needs and implement appropriate measures.
Identify learning barriers and tailor the learning process to achieve optimal patient outcomes.
Document data relevant to program evaluation.
Exhibit awareness and sensitivity to the rights of patients and significant others.
Involve family members in the care plan and facilitate patient transitions through the continuum of care.
Collaborate with patients and families to ensure timely and appropriate transfers to the next level of care.
Maintain awareness of safety issues and report unsafe conditions appropriately.
Act efficiently in emergency situations by following established protocols, remaining calm, informing relevant parties, and documenting events.
Demonstrate sound knowledge and decision-making in the care of designated patient populations.
Engage in self-directed learning and participate in continuing education for professional growth.
Recognize responsibility and accountability for personal professional practice.
Work collaboratively with physicians, nurses, patients, and families in a team environment to manage the overall function of Case Management.
Maintain strict confidentiality regarding patient, employee, and physician information.
Stay informed and provide updates on the activities of the State Peer Review Board and relevant regulations.
Utilize quality improvement tools and strategies in problem-solving initiatives.
Review potential critical care admissions against established criteria.
Assist in determining the appropriate care setting, such as ICU, telemetry, observation, inpatient, or outpatient.
Analyze healthcare resource utilization through concurrent reviews and medical care evaluations, identifying avoidable delays in hospital services.
Conduct retrospective reviews of medical records as necessary and collaborate with external case managers for continued stay reviews.
Monitor physician progress notes to ensure adequate and timely documentation supporting medical necessity for continued hospital stay.
Employ effective communication methods and skills, utilizing appropriate lines of authority.
Facilitate Utilization Management Committee meetings and activities.
Stay current on national developments in case management systems and recommend necessary changes to maintain a state-of-the-art concurrent case management system.
Incorporate culturally specific care into discharge plans and instruct other healthcare team members on established cultural norms within patient populations.
Engage in research activities and integrate research findings into practice.
Coordinate with other hospital functions, such as Health Information Management and business office, regarding review decisions, discharge planning, and fiscal communications.
Participate in multidisciplinary patient care conferences.
Coordinate with the business office to appeal inappropriate denials.
Analyze and implement standards relevant to care coordination.
Forecast, evaluate, recommend, and implement policies and procedures related to the concurrent case management program, including resource utilization and management of avoidable days.
Maintain confidentiality of all patient, hospital, and physician-related information.
Understand, uphold, and apply the hospital's philosophy.
Demonstrate the ability to relate to and work with chronically ill and disabled patients of all ages, as well as with emotionally distressed individuals.
Perform other duties as assigned or delegated by hospital management.
This job description summarizes the typical functions of the role and is not an exhaustive list of all possible responsibilities, tasks, and duties that may be assigned.
