Develops, implements and evaluates policies, standards, educational services and job descriptions in support of the mission of Central Texas Medical Center.
Demonstrates initiatives in developing, implementing and analyzing quality improvement activities and outcomes of the department which includes but is not limited to monthly Clinical Revenue audits as defined by Corporate Case Management.
Develops and submits budget assumptions, capital and annual budgets for the department.
Initiates activities to enhance revenue and support cost reduction as evidenced by managing department costs as well assisting all departments in providing the appropriate, medically necessary services to our patient population.
Provides initial departmental orientation, job training and information and confirms staff members’ abilities to fulfill job expectation
Maintains and updates policies and procedure manuals for department.
Analyzes and monitors compliance with accrediting and regulatory agency standards, including JCAHO, TDH, licensing boards, etc.
Resolves employee satisfaction concerns in a timely manner, assuring they have been thoroughly investigated and appropriate actions taken, including notification of Human Resources as necessary.
Participates in selecting outside sources for needed services when resources are not available with the hospital.
Resolves patient satisfaction concerns in a timely manner, assuring they have been thoroughly addressed and appropriate action taken.
Promotes teamwork with physicians and all health care providers, for promoting internal and external customer satisfaction and for appropriate resource management through the process of performance improvement.
Collaborates with Medical Staff to develop, review and revise the Case Management Plan to ensure adequate performance of all case management functions.
Works closely with the department CFO formulating the operating and capital budget, and monitors budget.
Employee performance evaluations completed and submitted to Human Resources within the required deadline.
Represents CTMC in a professional manner to employees and community members.
Participates in community organizations, meetings, and events representing CTMC.
Collaborates with Patient Financial Services, Central Billing Office (CBO),
Billing Specialists/Nurse Auditors, Health Information Management, Home health, Hospice, Performance Improvement and Risk Management in management of the revenue cycle.
Must maintain ability to function as a unit case manager or social worker as needed, utilizing the documentation and clinical review tools that are approved by Corporate Case Management.
Trends and reports avoidable days, LOS, re-admissions, and others items as requested.
Coordinates review and appeal of admission or technical denials
Recovery Audit Contractor (RAC): clinical liaison responsible for medical necessity reviews and submission of appeal letters to Health Information Management Director for submission to RAC.
Coordinates activities with the other departments to ease the availability and access to care for the patient.
Maintains adequate supplies and evaluates equipment on a periodic basis to provide safe efficient care and diagnosis for patients
Attends mandatory hospital in-services meetings.
Conducts monthly staff meetings.
Maintains confidentiality of all patient information according to federal and state guidelines and regulations.
Performs other duties as assigned.
Education & Experience
Be a graduate from an accredited school of nursing with five to ten years clinical experience and/or training and a BSN.
Four years experience in case management is required, two years experience in a nursing management position.
Licensure, Certification & Registration
Must hold a current license or be eligible for license as an RN in the state of Texas.
Certified Case Manager is either CMSA or ACMA.