Director Of Case Management-Must Be Rn

Director Of Case Management-Must Be Rn 

Melrose Park, IL

Healthcare / Health Services - Hospital Administration

Exp 2-5 yrs

Degree Bach

Job Description

Reporting to the Chief Financial Officer and working under general supervision assumes the primary responsibility for directing the Case Management Department’s processes and functions. Collaborates with various allied health professionals to promote and ensure that the proper quality of care is provided and outcomes are achieved in a timely and cost-effective manner. Utilizes an interdisciplinary process to assess, plan and provide patient care for specific diagnoses from pre-admission through aftercare. Assists in organizing internal processes and systems to prevent avoidable hospital days. Promotes appropriate post-hospital utilization of resources, adequate education of patient and hospital staff, and decreased incidence of re-admissions.  

PRINCIPAL DUTIES AND RESPONSIBILITIES:

1. Oversees the pre-screening of scheduled cases and admissions for appropriate criteria/pre-certs/approvals.

2. Assures for the proper patient care coordination including but not limited to: Admission Assessment, planning, implementation and evaluation with communication to other departments and outside agencies. 

3. Provides continuing analysis on LOS, average charge, readmissions and patient outcomes for a Case Management report.

4. Utilizes an interdisciplinary process to assess, plan and provide patient care for specific diagnoses from pre-admission through aftercare. 

5. Advises physicians of special documentation requirements when needed and assists them in identifying alternatives to cases that do not require acute care.

6. Negotiates with physician/payers in advance and assists in arranging transfers or alternate placement when indicated.

7. Facilitates and collaborates with Case Managers and other allied health professionals to promote and ensure that quality care is provided and outcomes are achieved in a timely and cost-effective manner.

8. Serves as a clinical instructor for case managers in education, training and mentorship.

9. Develops and maintains a departmental budget for the Case Manager staff and a quality assurance plan.

10. Coordinates activities to develop and implement departmental and corporate goals. 

11. Develops and reviews the annual updating of the Departmental Plan, monitors trends and variances from expected outcomes and implements strategies to resolve them.

12. Develops, administers and reviews policies and procedures as required.

13. Participates in the measurement of patient/family/decision maker expectations, involvement in care decisions and satisfaction.

14. Actively engaged with other areas of the hospital in the appropriate post-hospital utilization of resources, adequate education of patient and hospital staff and decreased incidence of re-admissions.  

15. Coordinates the activities of the Utilization Review Committee and works closely with the Physician Advisor in this role.

16. Assists in gathering data related to indicators for the department on a regular basis analyzes the data and creates action plans for performance improvement.

17. Reviews patient satisfaction data. Participates in the appropriate follow-up of any companies and handles department performance improvement.

18. Hires, promotes, demotes, separates and writes/administers performance evaluations to subordinate staff as necessary within their assigned area.

19. Conforms to the established Standards of Behavior

20. Other duties as assigned

JOB SPECIFICATIONS:

1. Current licensure as a registered nurse in the state of Illinois.

2. Current certification in an approved Case Management Program preferred

3. Three (3) years of relevant clinical experience required, with a minimum of two (2) years or relevant management experience.

4. Three (3) years of Utilization Management/Case Management experience, preferably in an acute hospital setting

5. Extensive knowledge in reimbursement methodology and Case Management activities

6. Critical thinking skills, effective written and verbal communications skills, strong self-initiative and interpersonal skills

7. Strong Leadership skills.

SKILLS AND CERTIFICATIONS

Must Be RN 

Hospital Case Management Experience-Plus