Job Summary

The Director of Case Management is responsible for the day to day operations of the department. The Director will develop, implement, and review the Utilization Management Plan annually. The Director is responsible for coordinating and facilitating multiple resources, internal and external, into a unique and single approach to care coordination for each patient assigned case management services. The Director will identify and implement processes that support and promote efficient patient throughput across the healthcare continuum resulting in optimal clinical outcomes, appropriate utilization of resources, and appropriate and accurate reimbursement. The Director will provide leadership, communication, and supervision to the department staff to ensure HCA and facility strategy is operationalized.

Participates in providing patient specific care standards as directed, and follows service excellence standards to ensure high levels of patient satisfaction.

You will demonstrate leadership, collaboration, and effective communication skills in directing and managing the assigned fiscal and human resources in support of facility goals and objectives: establishes and communicates department goals and objectives; manages personnel and assesses staff accountabilities; care coordination; resource management; discharge planning; utilization management; department productivity targets; employee, patient and physician satisfaction;
You will identify and implement 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
You will develop, implement, and review the Utilization Management Plan annually: holds self and others accountable for successfully achieving approved plans; develops, monitors, and review action plans.
You will identify and champion new programs, system processes, and company initiatives which improve clinical and financial outcomes
You will direct department activities to minimize account denials, opportunity days and variances in length of stay; works collaboratively with colleagues to ensure resources are optimized
You will perform data analysis related to Case Management metrics; develop, implement and monitor action plans related to denials, avoidable days, LOS, QIO data (PEPPER reports, et al), and other identified case management metrics
You will provide feedback to Division Case Management Director on issues related to department operations: offer 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; participate in HCA Case Management and Division initiatives
You will demonstrate a commitment to teamwork and cooperation; communicate accurate information timely; collaborate with Physician Advisor; integrate case management, social services, utilization management, and discharge planning activities
You will proceed on Director’s initiative, in compliance with HCA standards, professional standards of practice and policy and procedure, to resolve identified issues
You will direct 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
You will develop and revise, implement, monitor, and evaluate 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
You will initiate and facilitate collaboration with hospital staff, PAS, managed care with a goal of contract compliance and decreasing payer denials or non-medically necessary days at the facility level
You will collaborate 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.
You will provide leadership to and actively participate with facility staff to identify, implement, or enhance Case Management programs consistent with HCA and facility strategy
You will implement and monitor regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives related to Case Management services; provide regulatory and compliance updates to staff, provide standards of practice updates, initiates / drives process changes to ensure compliance to such regulations and quality initiatives as it relates to Case Management
You will perform staff supervision to validate policy, procedure and standards are met; collaborate with Division Director prior to performing wide-spread records audits
You will assess learning needs of social worker and case managers: provide for on-going educational needs
You will oversee utilization management committee functions and effectives
You will coordinate department functions to ensure proper coding for the billing of provider liable claims with the PAS, HIM and Nurse Auditor

Shift: Full-time • Days 7-10 Hrs/Wkdays Only
Job Qualifications

Registered Nurse
Registered Nurse Diploma
Graduate of or completion of required coursework from an accredited school of nursing resulting eligibility for NCLEX examination. Must be able to communicate effectively both verb
BSN required
Previous leadership experience required (5-7 years)
Previous throughput experience would be helpful
oversight to NAMC & SDASH

Compensation: Salary range from Max salary $173k base plus eligible for 15% leadership incentive plan. Position would qualify for relocation

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