Director of Case Management

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Director of Case Management

Job Overview

Director of Case Management

Overview:

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Our Partner is seeking a Director of Case Management for a hospital in Southern California. 

General Duties for this role are as follows,

The individual in this position has overall responsibility for operational management of the Case Management Department, Social Services and Bed Control; including staffing, budgets and plans.

The individual’s responsibilities will include, but not be limited to the following activities:

a) Complying with relevant the company's policies including Case Management and Clinical Determination Policies b) implementing and revising the UM Plan and promoting cooperation with utilization review standards by the medical staff c) Maintaining / facilitating communication between the case management department and the physician advisor on a regular basis regarding utilization review and/or quality issues d) Maintaining / facilitating communication between the case management department and the physicians as well as other members of the healthcare team e) analysis of reports: LOS, avoidable days, disputes, InterQual and  associated metrics f) Responsible for implementation and compliance with all policies and regulations relating to the functioning of the case management department g) and all other duties as assigned

Attends a workshop webinar led by PMI Case Management leadership or designee that includes the company's Case Management Model and other topics specific to role and responsibilities.

Information used to perform job: patient data, healthcare staff documentation related to patient care, regulatory and payor requirements, budgetary and operations data

Software used to perform job: eCCM: Clinical data interface, InterQual, Case Management documentation, secure faxing, Avoidable Day tracking, Patient Medical Record and HPF, hospital specific Clinical Software, Enterprise Reporting: Decision Support reports, PMI reports, Care Discovery, Position Control

DEPARTMENT SPECIFIC DUTIES:

Priority 1. Oversee coordination of clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post- acute care) compared to evidence-based practice, internal and external requirements. (40% daily, essential),

Priority 2.  Oversee department operations (staffing, scheduling, education, budget etc).  (20% daily, essential).

Priority 3.  Perform data gathering, analysis and reporting.  (20% daily essential).

Priority 4.  Remain current with relevant clinical/ case management practices. Attend and participate in meetings related to Quality, Operational and Financial improvement (20% daily, essential).

All staff assigned to department (case managers, social workers, case manager assistants, administrative assistants).  Other responsibilities as assigned e.g. disaster preparedness

The metrics below provide an indication of the effectiveness of the individual in this role and may be used for evaluative purposes.  The list below is not meant to be exhaustive; other relevant metrics may exist.

    Compliance with the company's Case Management policies
    Obtaining valid physician order prior to bed placement
    InterQual reviews
    Observation hours
    Excess Days/ALOS
    Clinical disputes -  incidence and dollars
    Number and type of avoidable days
    Resource Utilization
    At least 5 hours of CEUs per year on topics related to Case Management.

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