Provides leadership, direction, mentoring and coaching to hospital case management departments. Ensures that hospital and corporate case/resource management programs are planned, prioritized, and executed in a manner consistent with the promotion of safe and efficient patient care and clinical outcomes.
Works with corporate and facility management teams to monitor and positively impact EBITDA through LOS management, CMI/CDI improvements, cost per case/resource management, admissions increase, through-put, readmissions, ED medical redirection, etc.
DUTIES & RESPONSIBILITIES
1. The Director’s responsibilities include but are not limited to: ensuring effective case/resource management programs are in place at the hospitals; implementing the IASIS case/resource management model/templates/tools; collaborating with HIM to ensure that the concurrent coding/documentation improvement program is executed providing needed analyses of data; ensuring timely and accurate completion of the Clinical MOR (C-MOR) and ensuring that the appropriate data is available for review in hospital and medical staff committees and that action is taken to improve performance.
2. Works with corporate, market, and facility to provide guidance that enables the facilities to ensure efficient operation of case/resource management programs.
a. Activities related to this responsibility include but are not limited to: evaluating clinical processes and developing programs for improvement of case/resource management as needed; participating in the planning and implementation of product lines to ensure that case/resource initiatives are in place; periodically assisting with the evaluation of staff and staffing models ; participating in strategic planning activities related to case management work redesign; and focusing facilities on the efficient use of patient-related resources through effective case/resource management programs .
3. Collaborates with the clinical operations team and facility to attain Top 10% status for core measures, Top Box for Patient Satisfaction/HCAHPS, and attainment for benchmarks for AHRQ and other transparent performance/quality measures:
a. Activities related to this responsibility include but are not limited to: evaluating clinical processes and developing tools/programs for improvement; and ensuring that all IASIS developed and mandated tools have been implemented and are executing at the facility.
4. Ensures facilities are in compliance with accreditation and regulatory agency standards and conditions of participation as related to utilization/case/discharge planning.
a. Activities related to this responsibility include but are not limited to: oversight of accreditation and CMS activities; ensure internal audit findings have an action plan developed and items completed within 90 days of completion; ensuring that an ongoing survey readiness program is in place at each hospital; working with facility staff to prepare for or respond to regulatory agencies; review and approve all correspondence between facilities and regulatory agencies relative to the standards and conditions of participation and action plans; and attend and support the facilities when licensing/regulatory agency surveyors are onsite as needed .
1. Implementation of the HMMQP (Hospital Medical Management and Quality Program), accountable for outcomes/success of hospitals in the Division:
a. Case/resource management program
b. Denials management (concurrent/retrospective)
c. Clinical Documentation Improvement (CDI) in collaboration with HIM
d. Admission protocols use
e. Collaboration with hospitalists and employed physicians
f. Efficient operations within ED – case management
g. Collaboration with Managed Care
2. Implementation of the C-MOR process and focus/execution of the hospitals.
3. Education, training, and orientation of Hospital Case Management.
4. Expert knowledge of commercial criteria sets/subsets and Medicare benefit policies.
5. Working knowledge of IASIS Healthcare information systems that support all functions supported by the position.
6. Creativity, innovation, and value brought to IASIS for implementation throughout the system.
7. Ability to write and verbally/physically deliver professional presentations to small and large audiences.
8. Travel required 80-90%. Requires that the Director to be in facilities working with the Director of Case Management and staff to ensure that IASIS case management programs are being utilized and implemented effectively.
9. The Director will be responsible for the design and re-design of the Case Management tools as the market changes and opportunity are presented for growth of each market.
American Organization of Nurse Executives - 2 years ago