Manager, Case Management Services
1 month ago
Position Summary:
Responsibility for the management of daily operations for Case Management and other Clinical Effectiveness activities. Collaborates with leadership in the planning, prioritization, development, and implementation of case management and clinical effectiveness improvement efforts. Assists in the development, management, and implementation of comprehensive strategic initiatives in the areas of clinical effectiveness, quality improvement, regulatory compliance and related areas to support and enhance achievement of profitability and market share targets across the various service lines. Develops a strategic plan for areas of responsibility in collaboration with key organizational leadership; defines staffing requirements and resources needed to support these activities. Manages the daily activities of case managers and social workers to ensure patients’ needs are met and to move patients smoothly and seamlessly through the continuum of care. Participates in activities related to the achievement and maintenance of various regulatory and accreditation requirements. Plans and budgets for the department and develops and implements LEM goals and objectives as necessary to achieve stated outcomes. Accountable for the principles of excellence modeling and holding others accountable to Covenant Health’s Standards and Behaviors.
Responsibilities Knowledge of clinical quality/effectiveness, licensing, regulatory compliance, and operational standards applicable to the healthcare industry Collaborates with leadership in the planning, organizing, prioritization, development, implementation, and evaluation of clinical effectiveness/case management improvement efforts. Analyzes qualitative and quantitative performance data; communicates results; initiates actions based on results. Develops a recognized state of the art Case Management System that links cost of care with quality of care to demonstrate value. Facilitates information and data support for the facility. Develop systems or processes that assure data is readily available on outcomes, cost, and other indicators to allow teams to set goals and make changes in performance. Works with leaders, physicians, medical staff committees, staff and teams to identify or monitor their key processes, patient outcomes, customer service measures, and work environment in relation to clinical effectiveness/case management in order to recognize opportunities for improvement. Ensures alignment with mission/purpose, vision, values, behaviors and strategic initiatives of the organization. Challenges, coaches, and mentors individuals and participate on teams in a way that supports creativity, innovation, independent thinking, and responsiveness to changes in the healthcare industry and the needs/expectation of our customers. Manages the activities of the department personnel to ensure patients’ needs are met and to move patients smoothly and seamlessly through the continuum of care. Assures processes are in place to minimize denials of claims by managed care organizations and insurance companies. Directs growth and development of the department personnel. Develops, implements, and sustains a strong Case Management Model and serves as a role model for the professional practices. Directs growth and development of department personnel to include, providing mentoring, precepting and staff education as needed to assure maximum staff knowledge and expertise in the clinical field for unit assigned. Works with staff to develop action plans to obtain knowledge, skills, and expertise to assure staff can meet expected objectives. Maintains an awareness of healthcare trends, regulatory and accreditation requirements and assist staff who is responsible for achieving compliance. Participates in preparation for TJC, CARF, and state surveys and inspections as appropriate. Attends Committee meeting related to these activities. Develops and implements a department budget that reflects effective management of resources to provide service. Works in close collaboration with Covenant Health’s overall quality and performance improvement strategy, as well as the quality improvement strategies of other entities within the system. Facilitates work groups to effectively implement clinical effectiveness/case management strategies. Collaborates effectively with clinical leadership to achieve length of stay and financial goals for care processes. Demonstrates the ability to forecast, evaluate, develop, and implement policies and procedures necessary to support the organizational commitment to the clinical effectiveness/case management strategies. Works with senior leadership at the facility and at the Covenant Health System level to develop a collaborative practice environment. Facilitates effective communication of financial and clinical outcomes through the clinical leadership structure to physician’s and other key stakeholders. Demonstrates expertise in project facilitation and implementation strategy. Serves as a role model to employees and assists in strengthening the role of discharge planning, patient teaching, and patient preparedness for discharge components of the staff nurse role. Collaborates with the Risk Manager to assess potential exposures related to nursing practice. Develops action plan(s) to address identified exposures through a matrix reporting relationship with the Risk Manager. Assists risk manager with root cause analysis of sentinel or other significant events as appropriate. Make presentations as required to physician and hospital groups including senior and executive leadership. Serves as a direct link with Policy and Procedure activities. Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives and participates in quality improvement initiatives as requested. Performs other duties as assigned. QualificationsMinimum Education:
Graduate of an approved nursing school required.
Minimum Experience:
Five (5) years’ experience in healthcare, with three (3) years in a leadership position required.
Licensure Requirements:
Current TN license as Registered Nurse. CCM or CPHQ preferred.
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