Supervisor of Hospital Care Management

2 weeks ago


Reno, Nevada, United States Renown Health Full time
Job Summary

This position is responsible for the supervision of the Hospital Care Management Department. The purpose of the Hospital Care Management program is to promote quality of care, cost-effective patient outcomes, efficient resource utilization, while meeting the needs of the patient, family, referring physicians, agencies, and payer sources.

Key Responsibilities
  • Plan, organize, manage, and evaluate Utilization Management and Case Management teams.
  • Monitor achievement of program objectives and implement program changes to improve outcomes.
  • Collaborate with the Manager to prepare, administer, and monitor departmental operating and capital budget and maintain budgets within allocated funds.
  • Participate in the development of policies and procedures of the Department.
  • Allocate and assign staff for proper utilization of personnel in relation to patient, service line, and organizational needs.
  • Initiate hiring and termination decisions, and perform timely annual evaluations and coaching sessions.
  • Schedule and monitor assignments, and control staffing levels to meet budgetary guidelines.
  • Provide counseling, training, and address disciplinary problems.
  • Maintain a supportive attitude towards department and facility goals, plans, policies, and procedures.
  • Promote the role of utilization management and case management within the Health System by effective liaison with managers, directors, and physician leaders.
  • Participate in the planning and development of educational programs for Utilization Management and Case Management staff.
  • Coordinate and document departmental orientation and in-service training.
  • Provide expertise and direction to Hospital Care Management staff for solving complex clinical and financial patient situations regarding reimbursement issues, discharge planning, utilization review, continuity of care, and systems management.
  • Support a culture of continuous quality improvement.
  • Work within a team environment to manage the total function of the Hospital Care Management service.
  • Actively participate in organizational committees.
  • Participate in activities of professional associations.
  • Promote a positive, safe environment.
  • Keep abreast of current professional standards in the health field and make recommendations on changes in policy and programs.
  • In collaboration with the treatment team, attending physician, and external entities, may provide direct service care to patients.
Requirements
  • Thorough working knowledge of Medical Terminology.
  • Demonstrated knowledge of Utilization Management and Case Management principles and methodology.
  • Knowledge of Levels of Care (Acute care, Critical Care, Acute Rehab, LTAC, SNU, Subacute, Outpatient, Home Health, Day Tx).
  • Thorough working knowledge of Government, county, private, and workers compensation funding sources.
  • Eligibility criteria.
  • Criteria for determining level of care, and familiarity with managed care (HMO, PPO, PSO, and capitation).
  • Federal and State regulatory requirements and URAC standards.
  • Demonstrated ability to Communicate effectively with health care professionals and external case managers.
  • Identify obstacles to patient progress and barriers to discharge.
  • Problem solve with medical team to remove such barriers.
  • Maintain professional relationships; work effectively and collaboratively with other members of the medical team.
  • Actively pursue continuing education and training opportunities in Utilization Management or Case Management.
  • Ability to maintain knowledge regarding standards of care, case management/utilization principles and approaches, Social Services, discharge management and Spiritual Care.
  • Ability to maintain confidentiality regarding the medical record.
  • Understand insurance and payer requirements.
  • Demonstrate the knowledge and skills necessary to provide care based on physical, motor/sensory, psychosocial, and safety appropriate to the age.
  • By nature of current license for RN and department evaluation competency is demonstrated for ability to perform job duties.


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