GENESIS HEALTHCARE SYSTEM
 

In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an ‘owner’ of Genesis and keep our patients at the center of everything we do - always. 

Position Details:

Work Shift:

Varied Shift (United States of America)

Scheduled Weekly Hours:

40

Department:

Inpatient Care Management

Overview of Position:

Responsible for developing, planning, evaluating, and coordinating comprehensive patient care across the continuum, to enhance quality patient care while simultaneously promoting cost-effective resource utilization. Provides director-level oversight of Inpatient and ED Case Management, Utilization Management and Clinical Documentation Integrity programs, ensuring alignment with organizational goals and regulatory requirements. Monitors patient care, including utilization, quality assurance, discharge planning, continuity of care, and case management activities, and ensures that these functions are integrated into overall hospital operations. Coordinate and monitors activities with appropriate members of the health care team to promote efficient use of hospital resources, facilitate timely discharges, prevent and control infections, promote quality patient care, and reduce risk and liability. Collaborates closely with coders and revenue cycle teams to optimize clinical documentation and support accurate coding, reimbursement, and compliance initiatives.

ESSENTIAL DUTIES
1.    Responsible for identifying tracking mechanisms in order to evaluate and achieve optimal financial outcomes, to enhance quality patient care, and promote cost-effective resource utilization.
2.    Uses data to drive decisions, plan, and implement performance improvement strategies for case management, utilization management, and clinical documentation integrity
3.    Coordinates daily activities of the Case Management, UM, and CDI Department in order to promote quality patient care, efficient use of hospital resources, facilitate timely and adequate discharges, and reduce risk and liability.
4.    Investigates and initiates follow-up on utilization denials, contract negotiations, and external regulatory agencies’ requirements.
5.    Directs operations of our Physician Advisor Program, including analysis of performance through reporting and committee involvement and oversight.
6.    Actively serves on hospital committees and teams and facilitates opportunities for employees to do the same.
7.    Develops, performs, and improves personal and departmental knowledge of computer software and reporting functions.
8.    Organizes and oversees the maintenance of denial and appeal activity.  Follows up with physicians and others when indicated.
9.    Prepares or coordinates the preparation of periodic and special reports required by various agencies, insurance contracts, and for hospital committees.
10.    Analyzes and trends data results in order to incorporate efforts and information results with existing systems to optimize the efficiency of operational systems through strategic quality leadership.
11.    Facilitates growth and development of the case management program, utilization management ( including physician advisor program and clinical documentation integrity (CDI), in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities, as needed. 
12.    Develop new resources where gaps exist in the system as identified through research and data analysis to meet and enhance the quality/efficiency of comprehensive patient care and/or basic human needs for the community.
13.    Interact with Corporate Consulting and Business office on issues such as contracting, billing, reimbursement, denials, and physician reports cards, and collaboratively initiate improvements related to these areas.
14.    Maintains hospital compliance with the Quality Improvement Organization (QIO) and CMS guidelines.  
15.    Maintains professional knowledge by participating in educational seminars and opportunities.
16.    Participates in Population Health work at an organizational level, including active involvement with the System-Wide Care Management Team and Value-Based Care Delivery

QUALIFICATIONS
1.    Master’s degree in nursing, Healthcare Administration, or Business Administration required.

2. Current Ohio RN licen