Director-Case Management /Utilization Review

Responsibilities:

• Responsible for all fiscal matters within the department.
• Prepares and reviews annual budget, both operational and capital for department.  Investigates and reports variances between budget and actual expenditures.
• Supervision and oversight of Utilization Review and Appeals coordinator positions with responsibility for coordinating with business office.
• Oversight of UR software entries and written record-keeping by case managers; collaboration with Access Center and Business Office to rectify issues.
• Responsible for identification, monitoring and reporting trends in insurance provider adverse benefit determinations and reporting these events to clinical staff and hospital administration.
• Responsible for reporting to Finance Department on Revenue Enhancement Cycle and Downgrades and Denial activity.
• Responsible to assure that departmental staffing is maintained within the approved/budgeted staffing complement to guarantee effective operation of the department.
• Responsible for the direct supervision of Social Services Supervisors/Clinical Coordinators, Appeals Coordinator, Secretary, and Junior Case Managers.
• Oversees hiring, orientation, and ongoing monitoring of Per Diem staff to optimize and support full-time staffing including weekends and holidays.
• Develops and maintains current criteria-based job descriptions and performance evaluations.  Actively participates in the recruiting process in conjunction with the HR Department.  Consults with HR regarding trends in salary levels, recruitment, and retention.
• Responsible for maintaining student internships through liaison and contractual relationships with graduate schools of social work.
• Sets goals and objectives for all employees consistent with their current occupation and ability to advance.
• Helps to develop and facilitate educational programming. 
• Oversees planning and implementation of any training programs for departmental staff. 
• Responsible to develop policies, procedures, and systems to efficiently carry out the role within the organization.
• Clearly articulates the role and function of the department to all departmental employees and other departments within the hospital.
• Develops and maintains a departmental set of policies and procedures consistent with the overall policies and procedures of the institution.  (For example, staff compliance with documentation standards.)
• Establishes operating systems that most effectively utilize departmental resources to carry out the role of the department most effectively.  This includes maintaining a relationship and communication with finance personnel to ensure that documentation supports billing and that authorizations are being properly entered.
• Coordinates programs and operational systems with other hospital employees to provide services to patients, employees, and guests.
• Actively participates in a departmental Performance Improvement program that routinely identifies, problem-solves, and resolves problems as they relate to both the department and the organization.
• Routinely evaluates all departmental systems, policies, practices, and programs to assess whether changes are required to maintain current industry trends or standards.
• Maintains an awareness of current trends and developments in their areas of management and makes recommendations to effect changes.
• Provides reports (oral and written) to hospital leadership as directed.
• Routinely solicits feedback and suggestions from staff.  When appropriate, acts upon such information to effect change within the department, and shares such information with leadership.
• Routinely shares with departmental employees all current hospital-wide communications and information on issues of general interest to the hospital community.  Conducts regular staff meetings.
• Oversee process for Mental Health Court, or civil mental health hearings.  Provide updates to hospital regarding changes in schedule or procedures.  Support training and oversight of orientation to the process.  Problem solves with involved parties any procedural or clinical challenges.
• Annually reviews Joint Commission guidelines of psychiatric services as they pertain to the department to assure that department follows these guidelines. 
• Annually reviews Medicare standards and assures that the department follows these standards.
• Takes all necessary steps to correct all discrepancies of the standards regarding Joint Commission, DHS, or CMS in a timely manner and reports such corrections to leadership.
• Sets standards in all departmental policies, procedures, and practices to be compliant with all applicable state, federal, local, and regulatory agency requirements.
• Effectively builds and maintains harmonious