Forrest Health
DIRECTOR-CASE MANAGEMENT
Forrest Health, Hattiesburg, Mississippi, United States, 39400
The director of case management is involved in the day-to-day operations, including directing, organizing, developing, and planning to ensure effective functioning and performance of the department. The director oversees and manages a team of case managers and the activities of physician advisors. Some responsibilities include oversight of the regional hospitals’ case management and utilization review activities, including the training of staff. Ongoing strategic planning includes the provision of leadership and the allocation of resources to assist with the movement of patients across the continuum of care from admission to discharge.
Develops and implements the philosophies, policies, procedures, outcome metrics, and goals for the case management department. Knowledgeable of healthcare reimbursement, managed care contracting and negotiations, the revenue cycle management process, utilization management, discharge planning, and community resources. Acts as an advocate to ensure that services and resources are delivered to meet the needs of the patient and their family. Actively resolves issues arising from daily operations that require collaboration and coordination with other departments.
Works in an administrative, financial, and clinical capacity related to planning, designing, implementation, and monitoring of patient care outcomes and systems necessary for an effective hospital's utilization management program. Oversees the functions of the utilization management committee on a regular basis. Directs the planning, designing, and implementation of the utilization review plan in accordance with the Center of Medicare and Medicaid condition of participation for utilization review guidelines as well as other contracted employers.
Participates in various committees and work groups. Assists with training and developing the case management staff, including coaching and providing direction to accomplish departmental goals and objectives on an ongoing basis. Understands, complies with, and communicates expected business ethics, state and federal regulatory requirements to department staff; assures that those supervised are compliant with expectations. Knowledgeable of federal, state, and local regulations related to utilization review, reimbursement, and case management.
Assists in maximizing reimbursement by monitoring appropriate admissions, length of stay, denials, DRG changes, and quality of care citations. Analyze data and develop reports, including monitoring trends and tracking the overall performance of the department. Provides consultation and education to facility leadership, clinical and financial personnel, and medical staff members related to case management, including utilization management and discharge planning practices. Provides leadership and direction to staff members. Demonstrates knowledge and skills to appropriately communicate and interact with patients, families, and visitors of all age groups while being sensitive to their cultural and religious beliefs.
Performance Expectations:
Demonstrate the ability to manage the daily operations of a department.
Demonstrate the aptitude for leading, directing, developing, and coaching others.
Demonstrates strong problem-solving and decision-making abilities.
Demonstrate the aptitude for utilizing interpersonal, critical thinking, conceptual, and technical skills.
Qualifications:
Education/Skills:
A Bachelor of Science Degree in Nursing is required. A Master's Degree in nursing, health care management, business administration, or other related health field from an accredited university is preferred. The initial RN degree must be from a non-online accredited program. ACM (American Case Management) or CCM (Certified Case Manager) is preferred.
Work Experience:
Five or more years of experience in hospital-based case management and/or utilization management functions is required. 3+ years of managerial experience required. Must have working knowledge and experience with healthcare regulations and policies.
Certification/Licensure - DUE UPON HIRE:
Licensed RN able to practice within the State of MS.
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Develops and implements the philosophies, policies, procedures, outcome metrics, and goals for the case management department. Knowledgeable of healthcare reimbursement, managed care contracting and negotiations, the revenue cycle management process, utilization management, discharge planning, and community resources. Acts as an advocate to ensure that services and resources are delivered to meet the needs of the patient and their family. Actively resolves issues arising from daily operations that require collaboration and coordination with other departments.
Works in an administrative, financial, and clinical capacity related to planning, designing, implementation, and monitoring of patient care outcomes and systems necessary for an effective hospital's utilization management program. Oversees the functions of the utilization management committee on a regular basis. Directs the planning, designing, and implementation of the utilization review plan in accordance with the Center of Medicare and Medicaid condition of participation for utilization review guidelines as well as other contracted employers.
Participates in various committees and work groups. Assists with training and developing the case management staff, including coaching and providing direction to accomplish departmental goals and objectives on an ongoing basis. Understands, complies with, and communicates expected business ethics, state and federal regulatory requirements to department staff; assures that those supervised are compliant with expectations. Knowledgeable of federal, state, and local regulations related to utilization review, reimbursement, and case management.
Assists in maximizing reimbursement by monitoring appropriate admissions, length of stay, denials, DRG changes, and quality of care citations. Analyze data and develop reports, including monitoring trends and tracking the overall performance of the department. Provides consultation and education to facility leadership, clinical and financial personnel, and medical staff members related to case management, including utilization management and discharge planning practices. Provides leadership and direction to staff members. Demonstrates knowledge and skills to appropriately communicate and interact with patients, families, and visitors of all age groups while being sensitive to their cultural and religious beliefs.
Performance Expectations:
Demonstrate the ability to manage the daily operations of a department.
Demonstrate the aptitude for leading, directing, developing, and coaching others.
Demonstrates strong problem-solving and decision-making abilities.
Demonstrate the aptitude for utilizing interpersonal, critical thinking, conceptual, and technical skills.
Qualifications:
Education/Skills:
A Bachelor of Science Degree in Nursing is required. A Master's Degree in nursing, health care management, business administration, or other related health field from an accredited university is preferred. The initial RN degree must be from a non-online accredited program. ACM (American Case Management) or CCM (Certified Case Manager) is preferred.
Work Experience:
Five or more years of experience in hospital-based case management and/or utilization management functions is required. 3+ years of managerial experience required. Must have working knowledge and experience with healthcare regulations and policies.
Certification/Licensure - DUE UPON HIRE:
Licensed RN able to practice within the State of MS.
#J-18808-Ljbffr