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Chief of Case Management Services
2 months ago
Position Overview
The Chief of Case Management Services, reporting directly to the Chief Nursing Officer (CNO), plays a pivotal role as part of an interdisciplinary team dedicated to coordinating the provision of healthcare services that yield optimal outcomes for patients and their families, while adhering to available financial and social resources.
Qualifications and Experience
Education:
Graduation from an accredited nursing or social work program and possession of a current AR Registered Nurse or Social Work license.
Experience:
A minimum of 5 years in acute clinical settings and at least 3 years in Clinical Case Management or Utilization Review (preferred).
Additional Skills:
Ability to interact effectively with a variety of individuals and manage several complex situations simultaneously. Candidates must maintain adequate physical and mental health to meet job performance standards. Theoretical knowledge of nursing processes, case management, and continuity of care is required. A strong motivation for self-direction, integrity, and initiative is essential. Attention to detail and follow-up is critical. Candidates should demonstrate supervisory skills and exhibit leadership, creativity, and accountability.
Licenses/Certificates:
Current RN license in Arkansas or Social Work license is required.
Key Responsibilities
To excel in this role, the individual must successfully perform the following essential duties:
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.
Maintain professional ethics in safeguarding confidential information regarding patients, families, and employees.
Report hazards and take appropriate action.
Participate in safety training programs.
Support the Hospital's mission and vision statement.
Apply standard admission criteria to pre-screen admissions, determining the necessity of admission and level of care, and complete 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 complete variance reports.
Contribute to the development of a goal-oriented discharge plan of care that is prioritized based on medical diagnoses, issues, 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 proficient use of computers, telephones, copiers, and fax machines.
Provide ongoing education to hospital staff and medical personnel regarding case management, utilization review, and appropriate documentation for admission and continued stay criteria.
Support patient and significant other learning needs and implement appropriate measures.
Identify learning barriers and customize the learning process to achieve optimal patient outcomes.
Document data relevant to program evaluation.
Demonstrate 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, following established protocols, remaining calm, and documenting events.
Exhibit sound knowledge and actions in the care and decision-making for designated patient populations.
Engage in self-directed learning and participate in continuing education for professional growth.
Understand and uphold accountability for personal professional practice.
Collaborate effectively with physicians, nurses, patients, and families in a team environment to manage the overall function of Case Management.
Maintain strict confidentiality regarding patients, employees, and physicians.
Stay informed and provide updates on the work of relevant regulatory bodies and their scope of work.
Utilize quality improvement tools and strategies in problem-solving activities.
Review all potential critical care admissions against established criteria.
Assist in determining appropriate care settings.
Analyze healthcare resource utilization through concurrent reviews and medical care evaluation studies, identifying avoidable delays in hospital services.
Conduct retrospective reviews of medical records as required and collaborate with external case managers for continued stay evaluations.
Monitor physician progress notes to ensure adequate and timely documentation supporting medical necessity and appropriateness of continued hospital stay.
Utilize effective communication methods and skills, adhering to lines of authority.
Facilitate Utilization Management Committee meetings and activities.
Stay current on national developments in case management systems and recommend changes as necessary to maintain a state-of-the-art concurrent case management system.
Incorporate culturally specific care into discharge plans and instruct other healthcare team members in complying with established cultural norms.
Engage in research activities and integrate research outcomes into practice.
Coordinate with other hospital functions 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 relevant standards related to care coordination.
Forecast, evaluate, recommend, and implement policies and procedures related to the concurrent case management program, including resource utilization.
Maintain confidentiality of all patient, hospital, and physician-related information.
Understand, uphold, and apply the hospital's philosophy.
Effectively relate to and work with chronically ill and disabled patients of all ages, as well as emotionally distressed individuals.
Perform other duties as assigned or delegated by a supervisor or hospital management.
This job description summarizes the typical functions of the role and is not an exhaustive list of all responsibilities, tasks, and duties that may be assigned.
