GENERAL SUMMARY OF DUTIES – The Case Management Managers primary responsibilities include: The manager of case management is responsible and accountable for the implementation of the case management program at the hospital level.
The components/roles of the inpatient case management program consist of the following: care facilitation, utilization management, case management and discharge planning.
SUPERVISES – Case Managers and Social Workers
DUTIES INCLUDE BUT ARE NOT LIMITED TO
• Provide leadership, education and supervision for the day to day workflow of Case Managers and Social Workers.
• Monitor Case Management Department’s documentation to ensure meets regulatory compliance.
• Collaborate with Chief Financial Officer and Quality Department to develop and maintain quality improvement programs and trending of data (e.
g.
Avoidable Days , Readmissions) .
• Maintain skills in case management and utilization review to allow for coverage of patient caseload to cover staffing needs of all areas of hospital.
• Communicate with physicians concerning patient needs and aid with development of appropriate plan of treatment and assist with level of care and bed placement assignments .
• Directly responsible for personnel actions including hiring, performance appraisals ,employee schedules, and maintain payroll records and time reports in KRONOS.
• Facilitate daily Multidisciplinary Rounds to provide collaboration with other disciplines to provide holistic patient care.
• Participate in discharge planning.
Provides necessary education and resources to meet the discharge needs of individual patients and families.
• Active participant of Utilization Review Committee and Revenue Recycle Committee.
• Promote efficient utilization of clinical resources.
• Promotes the appropriate amount of resources are used based on patient acuity.
• Assures appropriate level of understanding, awareness and compliance with all applicable Joint Commission, CMS, state and local agency laws, internal/external regulations, guidelines, policies, procedures and professional standards.
• Other duties as assigned.
KNOWLEDGE, SKILLS & ABILITIES
• Working knowledge of payer requirements and discharge planning regulations that support the effect for the development of departmental policies, procedures and standards .
• Working knowledge of Medicare, managed care, inpatient, outpatient and home health continuum, as well as utilization management , discharge planning and case management .
• Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.
• Working knowledge of concepts of associated with performance improvement.
• Self-motivated, proven communication skills, assertive, able to work independently and as a team member.
• Demonstrated effective working relationships with physicians.
EDUCATION
• Graduate of an accredited program of Registered Nursing.
• Diploma in Nursing with 2-3 years management experience is minimum requirement.
Bachelor of Science in Nursing degree preferred.
EXPERIENCE
• Minimum of two years of Case Management experience in utilization management, case management, discharge planning or other cost/quality management program.
• Two to three years previous management experience is preferred with minimum of two years’ experience in hospital- based nursing.
CERTIFICATE/LICENSE
• Current RN license
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