Manager: Case Management
The Gammill Group - Columbus, OH

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MANAGER CASE MANAGEMENT – MOUNT CARMEL

THE COMPANY

Mount Carmel Health System (MCHS) has retained The Gammill Group to conduct an executive search for a Manager Case Management. With more than 8,000 employees, 1,500 physicians and 1,000 volunteers, MCHS has serviced the central Ohio marketplace for more than 125 years. MCHS is committed to providing quality care and is driven by a mission to heal body, mind and spirit; to improve the health of its communities; and to be a good steward of its resources. Each year, MCHS serves more than a half million patients and provides tens of millions of dollars in uncompensated benefits to the community.

MCHS consists of five operating divisions:
  • Hospital Division that includes Mount Carmel East, Mount Carmel West, Mount Carmel St. Ann’s and Mount Carmel New Albany
  • Ambulatory Care and Joint Ventures Group that includes ambulatory care programs and services as well as physician joint ventures
  • Physician Practice Division that employs over 100 physicians
  • Education Division that has six physician medical residency programs and Mount Carmel College of Nursing
  • Managed Care Division that includes a Medicare HMO (MediGold) and a PHO
Located near downtown Columbus, Mount Carmel West is the original hospital in the health system and is a Level II trauma center. Mount Carmel East hospital was built in 1972, and now has the busiest adult emergency department in greater Columbus. St. Ann’s hospital joined MCHS in 1995, and is a community hospital located in the Northeast suburb of Westerville. Mount Carmel New Albany Surgical Hospital joined the system in 2007, and is a specialty hospital focused on inpatient and outpatient orthopedic, neurologic and musculoskeletal care. The overriding vision for the system is that Mount Carmel is “one hospital with four sites.” The intent is to develop standards of care delivery across the system and through a culture of sharing and learning from each other, capitalize on the strengths of each hospital.

In addition to the hospitals, MCHS has outpatient service lines, home care, palliative and hospice care, home medical equipment services, an ambulance and mobile intensive care service, and a community outreach program for the uninsured and underinsured.

As a system, Mount Carmel Health has revenues in excess of $1 billion and operates approximately 1,000 beds with over 55,000 admissions.

Mount Carmel also has an affiliation with Fairfield Medical Center for Diley Ridge Medical Center, a new medical complex featuring the first freestanding emergency and diagnostic center in central Ohio with an attached medical office building.

Trinity Health

Mount Carmel is a member of Trinity Health, the 10th largest health system and the fourth largest Catholic health care system in the country, and is devoted to a ministry of healing and hope. Serving through a network of 50 acute-care hospitals, 432 outpatient facilities, 33 long-term care facilities, and numerous home health offices and hospice programs in ten states, Trinity Health draws on a rich and compassionate history of care extending beyond 140 years.

Position Profile for System Director Case Management Page 2

Trinity Health and Catholic Health East (CHE) recently announced plans to consolidate operations. Combined, the new system would generate annual operating revenue of about $13.3 billion, with $9 billion coming from Trinity and $4.3 billion from CHE. Trinity owns 36 hospitals and manages 14 hospitals in 10 states. CHE owns 23 hospitals in nine states. The transaction also includes 89 continuing-care facilities and more than 87,000 employees total. The new organization will be close in size to the nation's largest not-for-profit system, St. Louis-based Ascension Health, which consists of 79 hospitals.

For additional information, please visit these websites:
Mount Carmel website: www.mountcarmelhealth.com
Trinity Health website: www.trinity-health.org

THE POSITION

The Manager of Case Management is responsible for planning, organizing, staffing, directing, and coordinating the scope of services originating from the Case Management/Social Work Services department, while functioning within the standards, policies, procedures, and guidelines of the Organization.

KEY RESPONSIBILITIES

  • Provides leadership and direction for all Case Management and Social Work Services employees at assigned site. This includes hospital based, clinic services, outpatient settings as well as the emergency department.
  • Develops and sustains case management or social work policies and procedures in collaboration with other Case Management/Social Work Services Site Managers.
  • Manages and participates in other policies in impacting utilization, reimbursement, patient care, and safety as well as general hospital discharge planning performance.
  • Develops, recommends, and implements goals and policies for the resource management of Case Management Social Work Services, including budgeting and allocation of human resources, capital expenses, physical facilities, and supplies.
  • Facilitates cost effective use of medical services and compliance with external regulations regarding discharge planning procedures, medical necessity, and allowable benefits.
  • Oversees and manages all audits pertaining to medical necessity for denial and appealable status.
  • Remains well versed on CMS and Joint Commission or other regulatory changes impacting case management and develops and implements policy changes to support such changes.
  • Participates in planning and facilitates educational opportunities for case managers, physicians, and patient care services for improved patient stay management, denials, patient type, and utilization of available health care services.
  • Coaches and mentors case management staff to optimize work prioritization, work organization, understanding of payer needs, key elements of a patient review, and discharge planning effectiveness.
  • Establishes and maintains strong, positive relationships with the medical staff, community agencies, regulatory bodies, payers, and other Mount Carmel departments.
KEY INITIATIVES – FIRST SIX MONTHS

  • Focus on staff development.
  • Assist in advancing key hospital initiatives in meeting metrics for LOS and observation versus inpatient status.
PERSONAL STYLE

  • Demonstrates a commitment to superior customer experiences with a service-oriented attitude.
  • Comfortable leading a culture of change.
  • Ability to apply experience, analysis, intuition, and communication skills in maintaining and improving the quality of services provided by the Case Management and Social Work Services department.
  • Evidence of leadership skills, crisis intervention, critical thinking, decision making, and conflict management.
Position Profile for System Director Case Management Page 3

  • Comfortable operating in a collaborative environment and works well with all departments that interface with Case Management such as Finance, Managed Care, PFS, Registration, and HIM.
  • Demonstrates political savvy.
  • Possesses strong oral and written communication skills as well as effective listening skills.
  • Demonstrates high degree of self-motivation, assertiveness and goal-attaining capabilities.
  • Ability to generate and support new ideas and innovations.
  • Identifies, analyzes and solves problems effectively.
  • Strong analytical and data management skills.
  • Organizes, plans, and manages time effectively.
  • Demonstrates ability to effectively lead and manage teams and people.
  • Provides staff with opportunities for continued career growth and development.
EDUCATIONAL AND EXPERIENTIAL QUALIFICATIONS

  • Registered Nurse with at least a Bachelor’s Degree or Social Worker with a Master's Degree.
  • Licensure / Certification: Nursing License through the State of Ohio or Social Work license of LISW or LISW-S.
  • Minimum of five years experience in the field of clinical nursing care or medical social work.
  • At least two years of management experience preferred.
  • Possesses knowledge of legal, regulatory, and accrediting standards related to utilization management and discharge planning.
  • Possesses current knowledge of Center of Medicare/Medicaid, managed care, payor systems, reimbursement as well as economic/social trends in health care delivery as well as an understanding of negotiation of community systems.
For more information, please contact:
Bonnie Trail
btrail@gammillgroup.com
Phone (614) 848-7726 ext. 1020
Fax (614) 848-7738
The Gammill Group
9200 Worthington Road Suite 101
Westerville, OH 43082
www.gammillgroup.com

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