Director Case Management
- Demonstrates leadership, collaboration, and effective communication skills in directing and managing the assigned fiscal and human resources in support of facility goals and objectives.
- Identifies and implements resource reduction strategies consistent with facility strategic plan with a focus on quality outcomes, reduction of length of stay, medical necessity and level of care.
- Identify and champion new programs, system processes, and company initiatives which improve clinical and financial outcomes.
- Directs department activities to minimize account denials, opportunity days and variances in length of stay; works collaboratively with colleagues to ensure resources are optimized
- Performs data analysis related to Case Management metrics; develops implements and monitors action plans related to denials, avoidable days, LOS, QIO data, and other identified case management metrics.
- Provides feedback to Division Case Management Director on issues related to department operations: offers input to Division Director on managed care contracting issues; best demonstrated practices; process improvement and utilization management activities; barriers to achieving goals and objectives of initiatives; participates in HCA Case Management and Division initiatives
- Demonstrates a commitment to teamwork and cooperation; communicates accurate information in a timely manner.
- Directs and integrates case management, social services, utilization management, and discharge planning activities
- Directs activities to identify and provide for the needs of the under resourced patient population to include patient education activities, patient assistance programs, and community based resources
- Develops and revises, implements, monitors, and evaluates processes to ensure outcomes are achieved related to managed care contracts; appropriate authorizations or determinations of medical necessity for all payers sources are obtained and documented.
- Initiates and facilitates collaboration with hospital staff, shared services, managed care with a goal of contract compliance and decreasing payer denials or non-medically necessary days at the facility level
- Develops, reviews, and implements policy and procedure.
- Identifies process improvement opportunities; develops, revises, implements, and monitors action plans.
- Collaborates with physician advisor and medical staff to ensure quality outcomes and patient throughput are maximized while supporting a balance of optimal care and appropriate resource utilization.
- Provides leadership to and actively participates with facility staff to identify, implement, or enhance Case Management programs consistent with HCA and facility strategy.
- Implements and monitors regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives related to Case Management services; provides regulatory and compliance updates to staff, provides standards of practice updates, initiates / drives process changes to ensure compliance to such regulations and quality initiatives as it relates to Case Management
- Assesses learning needs of social worker and case managers.
- Oversees utilization management committee functions and effectiveness.
- Coordinates department functions with the shared services, Health Information Management (HIM) and revenue integrity.
- RN with current state licensure, BSN required.
- Five years Nursing Case Management experience; Two years Director or Supervisor experience preferred
- Certification in Case Management, Nursing, or Utilization Review preferred
- Ability to establish and maintain collaborative and effective working relationships
- Ability to communicate effectively in oral, written and electronic formats
- Demonstrates analytical and critical thinking abilities with pro-active decision-making, problem solving and negotiation skills
- BLS – American Heart Association – required