The Manager of Case Management works in conjunction with other members of the interdisciplinary care team using a proactive approach to facilitate effective and efficient patient care during the hospital stay. The Manager of Case Management demonstrates initiative and self-direction in managing and providing oversight for the Case Management and Social Services Departments. This position is a working management position; the Manager of Case Management will perform all functions of Case Management in addition to supervising and ensuring staffing in the departments. Participates in providing patient specific care standards as directed, and follows service excellence standards to ensure high levels of patient satisfaction. ESSENTIAL JOB RESPONSIBILITIES
Qualifications: EDUCATION AND EXPERIENCE Required:
- The Manager of Case Management works in conjunction with other members of the interdisciplinary care team using a proactive approach to facilitate effective and efficient patient care during the hospital stay.
- Facilitate effective and efficient patient care during the hospital stay. Face-to-face visit with patients and/or family members for comprehensive assessment for discharge needs taking into account the patient's needs, current and prospective functional capacities, resources and support systems.
- Follow-up visits and phone calls with patients and/or families as needed
- Accurate and timely utilization review of patient charts to insure appropriate utilization of hospital resources and facilities
- Provision of clinical information to 3rd party payers in support of the patient's admission and/or continued hospital stay
- Active communication with the physicians regarding issues such as length of stay, admission and/or treatment criteria, and how to render services in the most cost effective setting
- Comprehensive assessment that takes into account the patient's needs, current and prospective functional capacities, resources and support systems.
- Collaborative formulation of appropriate and realistic patient-centered discharge plans including the arrangement of any necessary follow-up services such as durable medical equipment, home health and/or placement
- Advocacy in support of the patient's right to self-determination
- Acting as a liaison between patients, families, visitors, physicians, SDSAMC staff and/or other community service providers
- Community information and referral
- Thorough and timely documentation regarding the patient's problems, goals, plans and/or relevant case management interventions
- Participation in and/or facilitation of interdisciplinary care conferences
- Analyzes case management and social work functions and data.
- Prepares and reviews data analyses related to the effective of services: length of stay, avoidable days, reimbursement, resource utilization, and variances.
- Liaison between senior hospital management and departmental staff to communicate facility and departmental goals.
- Maintains regular and candid communication with the director to advise of departmental priorities and challenges and to recommend improvements.
- Provides oversight and direction of department operations.
- Directs concurrent reviews to ensure timeliness and accuracy and intervenes when patients do not meet medical necessity. Oversees and monitors processes to manage and respond to denials.
- Able to assist department with workload changes as appropriate and necessary to meet patient and facility demands.
- Participates in annual budgeting process and monitors departmental adherence.
- Maintains communication among staff members in the department.
- Assists director with employee performance evaluations, counseling, and interview process.
- Adheres and upholds all service behaviors as listed in the I CARE value commitment and other departmental initiatives.
- Employee's conduct must reflect the Company's values and a commitment to the Code of Conduct ethics and compliance program.
- Employee reflects SDSAMC Service Excellence standards in every interaction.
LICENSES AND CERTIFICATES : Required:
- Graduate of accredited Bachelor's Degree in Nursing or higher level education
- Master's degree in Social Work
- Clinical Interqual experience
- Five years of Case Management experience in an acute care setting
- Two years of supervisory or management experience
- Texas RN License or a Compact RN license from a NCLA Compact State
- BLS certification as per SDH policy
- ACLS certification as per SDH policy
- Reports to: Director of Case Management
- Positions supervised: Social Workers, and Case Managers
A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom