Director, Case Management - Case Management - Full Time 8 Hour Days (Salary) (Non-Union)

The Director of Care Coordination provides operational leadership, day to day supervision and administrative oversight to the Case Management and Social Services Departments by developing, interpreting and applying policies, procedures and strategies for both the inpatient and outpatient Norris populations and clinics. Responsible for departmental management, staff development and performance management.
 

Essential Duties:

• Demonstrates competency in the quality of work and knowledge of the job pertinent to the functioning of a Director, Care Coordination.
• Develops, implements and evaluates the annual Care Coordination / UM plan for the hospital which takes into account internal and external factors. The Care Coordination plan is designed and implemented in accordance with considerations for clinical quality, appropriate utilization of resources, timely discharge planning and payer requirements.
• Effectively manages, organizes and supervises the Care Coordination process for the hospital. Provides oversight to the plan of care with team members, clinicians, and patient/families as needed. Assists with difficult cases, communicates appropriately if the plan of care should be advanced or revised to achieve an effective discharge within established goals and available resources. Assists department staff to resolve barriers to discharge.
• Provides management oversight for services provided by social workers including psychosocial assessment, crisis intervention and supportive services for referred patients, families and staff. In conjunction with the Social Work Supervisor, formulates and implements programs to meet the psychosocial needs of the patient and family. Collaborates with all units of the hospital, physicians, nurses and other members of the healthcare team in planning the psychosocial care of the patient.
• Develops effective structures and processes to facilitate participation by physicians, pharmacists, nurses, Social Workers and other health professionals in multi-disciplinary care planning and discharge planning. In conjunction with the Physician Advisor, leads weekly interdisciplinary team reviews.
• Achieves department clinical quality, LOS and financial / budgetary goals.
• Identifies trends in utilization management, resource management, social service provision, quality management, risk management, and coding / compliance. Identifies those amenable to intervention through physician and staff education or process engineering. Assertively plans interventions and works with key individuals to see those processes to completion.
• Plans agenda for monthly utilization management committee. Preps committee chair and ensures committee recommendations are followed through to completion.
• Develops and uses measurable standards to monitor and evaluate quality and cost-effective utilization of resources in the delivery of care. Monitors space/resource requirements and utilization of outside resources.
• Compiles reports, analyzes data, and identifies significant trends in medical utilization data, such as lengths of stay, readmissions, and clinical outcomes. Reports variances through established channels. Consults with colleagues to clarify clinical details.
• Works cooperatively with the Business Office and Dispute Management teams to ensure accurate and timely claims processing.
• Understands economic and contractual impacts and facilitates pertinent communication to the staff and outside customers. Ensures that payor expectations for authorization, clinical reviews and use of contracted agencies and/or services are met. Communicates effectively with clinical staff regarding third-party restrictions on care delivery.
• Develops effective relationships with medical staff, referring physicians and managed care organizations.
• Ensures all departmental functions and activities are in compliance with appropriate regulatory standards, including, but not limited to: JCAHO, Federal, State, policies and procedures of USCUH corporate ethical and compliance standards and other applicable professional codes.
• In concert with Hospital Policy and Human Resources. Assures adherence to hospital Human Resource policies in all interactions. Responsible for all recruitment, selection, establishment of performance standards, training and disciplinary actions if needed. .Working in concert with Human Resources – responsible for all documentation to accurately support disciplinary actions including terminations. Develops an effective team for Care Coordination duties. Supervises contract staff, on-site reviewers and vendor reps.
• Proficient in the use of computers and computer programs necessary to perform job responsibilities. Demonstrates the ability to effectively train department staff in same.
• Expectations: Supports hospital’s mission and goals. Is committed to enforcing compliance