Description

SUMMARY:

The director of case management is responsible for the day-to-day operations in case management to include census management, patient care outcomes, overseeing the interdisciplinary team conference and utilization review. The Director of Case Management is a family and patient advocate and ensures that services provided and arranged meet the patient’s and family’s needs and those services are appropriate. Director of Case Management will ensure that documentation is completed to meet required standards for the department.

The Director of Case Management is responsible for training and education in the case management department. They are a part of senior leadership, and will effectively communicate with administration, medical staff, regarding service delivery, financial management and discharge planning and outcomes. The Director of Case Management will be responsible for training and onboarding process of new case management employees.

The Director of Case Management will work on team and relationship building. The Director of Case Management will support cultural diversity and ensure that culturally competent patient centered care is provided. 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

May include, but is not limited to the following:

To perform this job successfully, an individual must be able to perform each key function satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the key functions. 

Job Specific:

• Case management experience including utilization review and discharge planning
• Strong leadership skills
• Strong negotiation skills
• Skills in administrative functions of accountably, time management, and decision making
• Must be flexible to provide hands on case management 
• Must have great people skills, and have an ability to de-escalate problems with patients or families
• Review documentation of communication with patients, families, and physicians.
• Must be able to articulate effectively to family and patients and team members

Operations and Support Services:

• Demonstrates satisfactory level of interpersonal skills to interact with facility staff, Administration, patients, families, customers, vendors, and government agencies.
• Demonstrates and understands the importance of and respect for the rights, dignity, and individuality of each patient in all interactions.
• Demonstrates honesty and integrity at all times in the care and use of patient and hospital property.
• Knowledge of emergency and disaster procedures of the facility.
• Demonstrates respect for co-workers and responds to needs of patients by complying with hospital policies.
• Demonstrates ability to prioritize tasks/responsibilities and complete duties within allotted time.
• Appropriately accesses the resources of the company’s regional offices for consultation and program development support. Seeks out external resources through conferences, workshops, etc. as necessary. Routinely shares professional knowledge with staff, managers and hospital personnel.
• Ability to carry out the essential functions of this job (with or without reasonable accommodation).
• Assure participation in relevant in-service training sessions.
• Attend and participate in facility meetings as required.
• Access continuing education opportunities appropriate to responsibilities.
• Participate in hospital wide patient safety program identifying risks to patient safety and reducing healthcare errors.
• Perform other duties as assigned.

Job Function:

• Plan, coordinate and implement programs for the case management department. Manages programs and resources to maximize patient outcomes.
• Trains and retains qualified competent staff to provide case management and related series to attain or maintain highest practicable physical, mental and psychosocial well-being of each patient. Assures new employee orientation, regular performance reviews, reviews job actions taken by subordinates to assure that staff meet qualification and performance standards and can performs all essential functions of their job. Reviews staffing plans to ensure sufficient numbers of qualified staff according to budgeted funds. 
• Assess, plan, develop, implement and evaluate all performance improvement activities within department. Provide ongoing education to staff on performance standards. Develop culture of “100% compliance 100% of time. Collect and analyze outcomes and submit reports to regulatory agencies, administration, UR and MEC Committees.
• Communicates directly with patients, families, medical staff, nursing staff, interdisciplinary team members and department heads to coordinate care and services, improve organization and implementation of patient care to maintain quality of care. Evaluates patient outcomes and revises plan according to changes in patient needs. Manages customer’s perceptual outcomes effectively and responds timely.
• Assess patient’s condition, learning needs and family dynamics based on systematic data collection utilizing assessment skills and tools appropriate to the respective practice area. Develops a comprehensive plan of care and discharge plan based on the nursing assessment and integration of the medical plan utilizing patient’s family and other health care tam members.
• Participates in budgetary process. Submits proposals related to departmental budgetary staffing and planning. Provide relevant financial information to the CEO regarding financial needs and status.

Qualifications

Education

Graduate from a school of social work or RN

License/Certification

Current license for the discipline of degree for the state of practice. Current Basic Life Support (BLS) CPR certification through the American Heart Association. Both license and certifications must be maintained throughout employment.

Experience

• Three years’ experience as a hospital case manager.
• Two years’ experience in healthcare management.
• Ability to project a Professional Image. Knowledge of regulatory standards, compliance requirements and hospital policies and procedures. Working knowledge and ability to apply professional standards of practice in job situations. Strong organizational and analytical skills. Working knowledge of computer and software applications used in job functions (Order entry, data entry). Knowledge of IPR.

SUPERVISORY RESPONSIBILITIES:

Case management department

OTHER REQUIREMENTS:

Participates in or conducts company-wide sponsored training to safeguard against improper use and disclosure of patient’s protected health information. Monitors and ensures compliance with company policies, procedures, state and federal regulations and Accreditation Standards.

Company Specific:

• Adheres to dress code, appearance is neat and clean and wears appropriate identification while on duty.
• Adheres to all smoking or tobacco regulations established by corporate building owners, state or federal laws.
• Completes annual health, safety, and education requirements. Maintains professional growth and development.
• Maintains confidentiality of all patient and/or employee information to assure patient and/or employee rights are protected.
• Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age-appropriate care to the patient population served.
• Reports to work on time as scheduled; adheres to policies regarding notification of absence.
• Attends all mandatory in-services and staff meetings.
• Represents the organization in a positive and professional manner.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission, ethics, and goals of the hospital, as well as the focus statement of the department.
• Maintains current licensure/certification for position. 
• Consistently demonstrates superior customer service skills to patients, physicians, visitors, employees, and any other individuals with whom they may come in contact.
• Consistently follows departmental and hospital Health, Safety, Security, Hazardous Materials policies and procedures.
• HIPAA: Conduct job responsibilities in accordance with HIPAA privacy laws, follow hospital policy in provision of patient confidentiality. Able to identify patient confidentiality issues and reports to proper hospital personnel immediately.
• Compliance: Conducts job responsibilities in accordance with standards set forth in Code of Conduct, policy and procedures, applicable federal and state laws, and applicable standards.

Core Values:

Professionalism –To always maintain the highest standard and regard for others. Keep skills, competencies and required licensures/certifications current; displays mastery over attitude and behavior and pride in appearance. Consistently performs duties to the best of abilities.

Exceptional Care—Go above and beyond expectations by providing exceptional care to WOW our customers—patients, family, physicians, and each other.

Respect – Treating others as they would like to be treated; valuing others. Acknowledges the worth of others through professional greetings, proper telephone etiquette, patience, and common courtesy.

Fun - Having fun and celebrating small successes in our journey to achieve big.  Always demonstrates a positive attitude toward work and devotion to our passion and task at hand.

Teamwork –To function as a unit, with common goals, recognizing we can achieve far more as a team than as individuals. Cooperates with co-workers while performing duties leading to everyone being able to achieve success and giving recognition where it is due.

Integrity – To always be honest and trustworthy in all our relationships. Demonstrates adherence to a strict moral or ethical code in performance of duties by always seeking to do the right thing.

Accountability -- Responsibility of our actions that influence the lives of our customers and fellow workers. Takes ownership of all aspects of duties shown through reliable, timely performance and responsibility.

Responsibility – Maintains accountability by doing what is expected or beyond; assuring the appropriate tasks and project items are completed. Takes ownership of all aspects of duties shown through reliable, timely performance and accountability.

Knowledge/Skills/Abilities:

• Ability to function independently in all aspects, including project identification, evaluation, contract negotiations, and coordination with management and internal departments.
• Ability to represent the company in a confident, persuasive and positive manner.
• Good interpersonal, verbal and written communication skills.
• Ability to work under stress and respond quickly in emergency situations.