WIR Division Director, Case Management, Social Work and Denial Management
Franciscan St. Elizabeth Health - Lafayette, IN

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Position summaryThe Division Director is administratively responsible and accountable to provide leadership and direction for assigned departments within the WIR Financial Services. The Division Director assists the Regional Chief Financial Officer in accomplishing the goals, objectives, and mission of the division.Essential Job FunctionsPersonnel ManagementDirects/coordinates aspects of Case Management (CM), Denial Management Specialist (DMS) and Social Work (SW). Maintains an active presence in areas of assigned responsibilities. Assists Lead Coordinators for Case Management/Social Work in determining staffing needs and patterns in order to meet the changing needs of our patient populations, consistent with budgetary constraints. Interviews candidates; hires appropriately; regularly evaluates; completes corrective action/termination processes as appropriate, as well as provides feedback to staff regarding performance. Assists in assessing staff education and development needs; facilitates implementation of appropriate educational efforts. Operations ManagementMeets budget; articulates clearly any and all budget variances. Demonstrates ability to be forward thinking to have a vision, to make recommendations for appropriate changes. Directs and supervises director and coordinator in all aspects of departmental business. Demonstrates an understanding of and commitment to legal, ethical, and risk management issues. Conducts all activities in compliance with applicable laws and regulations and promotes the highest standards of business ethics and integrity. Demonstrates accountability and leadership in committee and task force work. Planning ManagementDemonstrates problem-solving skills and sound decision-making abilities. Develops departments goals and objective plans, with action points to meet those goals. Regularly reviews and reports progress toward goals. Articulates and supports organizational priorities, goals, and objectives. Participates in planning for the division, consistent with goals, objectives, and mission and coordinates departmental implementation to meet those goals. Prepares programs for survey readiness and audit completion of staff mandatory requirements. Provides and supports participation of staff in performance improvement to improve existing processes and enhance the effectiveness of the staff. Provides coordination, reporting and support to the Utilization Review Committee. Financial ManagementPrepares, manages, and evaluates capital and operating budgets. Meets budgetary goals. Uses resources appropriately. Participates in development, revision, evaluation of the revenue cycle process. Discerns reports, documents, statistical information, concerns, issues, accomplishments for programs, denials and appeals and revenue cycle related activities and submits information to appropriate sources as well as takes steps to resolve issues identified. Outcomes ManagementDemonstrates commitment to process to continuously improve clinical and financial outcomes. Responds to patient/family, staff, physicians, administrative and payor concerns for patient care. Facilitates effective patient care by establishing and maintaining a suitable environment for nursing practice and patient care. Maintains and monitors for patient care and outcomes. Facilitates education with physicians to better compliance Acts as a liaison with staff and physicians with documentation and denials/appeals process. Represents departments at key meetings and assigned committees. Works collaboratively with interdisciplinary teams, both internal and external to the organization, to improve patient care through effective utilization and monitoring of healthcare resources and assumes a leadership role to achieve desired clinical, financial and resource outcomes. Knowledge, Skills AbilitiesDemonstrate leadership abilities, effective conflict resolution skills and self directed. Excellent critical thinking skills to provide the ability to assess needs with multiple levels of complexity Strong organizational skills, analytical skills, written /verbal communication skills. Ability to tolerate frequent interruptions and demanding work load. Knowledge of CM, SW and DMS principles, procedures, and practices. Knowledge of resources, services, clinical standards, federal, state and regulatory guidelines preferred. Must be able to identify and provide for age-specific patient needs. Skill in operating job-related equipment. Minimum Position QualificationsEducation: Bachelor Degree in Nursing from an accredited School of Nursing required. Master in Business Administration or Masters in Nursing Preferred. Experience: Minimum of three to five years experience in nursing management or supervision preferred. Licensure/Certification: Must hold current Indiana nursing licensure.

Keywords: WIR Division Director, Case Management, Social Work and Denial Management

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