This position is responsible for the development and implementation of case and utilization management programs and services. This position provides leadership, direction and support for Case Management Services in the pursuit for best practice to achieve quality outcomes, reduce costs, and shape and interpret the standards required to ensure a high degree of patient, physician and employee satisfaction.
PRIMARY (ESSENTIAL) DUTIES
- Plans, directs and monitors the case and utilization management program(s). Provides advice, counsel, feedback and coordination to promote a collegiality between staff, physicians and the leadership team.
- Ensures that development of case management services across the continuum leads to outcomes supportive of the organizations strategic plan. Designs and implements processes to ensure appropriate care coordination in accordance with regulatory and standards of safety.
- Provides direction for multidisciplinary process improvement activities, including the establishment of performance measures to attain optimal clinical, operational, financial and satisfaction outcomes. Directs the collection, analysis and presentation of data on utilization patterns and other program outcomes.
- Directs personnel actions including recruiting, new hire actions, interviewing and selection of new staff, salary determinations, training, and personnel evaluations. This position also participates in the development of Case Management goals and objectives in accordance with company standards.
- Manages the financial and capital resources for case management services by monitoring operating revenue and expenses, establishing and maintaining cost control programs and developing and implementing new or revised programs and/or services. Develops and implements strategies to work with all external customers to ensure appropriate reimbursement.
- Develops and oversees the department budget in conjunction with corporate goals and objectives. This position is accountable for meeting annual budgetary goals.
- Assesses patient satisfaction in areas of responsibility; sets a high standard for staff and leadership to improve patient satisfaction as measured by survey scores.
- The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.
- Requires strong working knowledge of utilization management, care management, regulatory standards and reimbursement across the continuum of care.
- Must possess demonstrated skill in problem analysis, project management, contract negotiation, conflict resolution and oral/written presentation.
- Must possess demonstrated flexibility in responding to the needs of multiple constituencies with a service-oriented philosophy.
- Must have at least 2 years of management experience and two years of providing care in an acute care setting.
- Bachelor's Degree in Social Work or Nursing; Current Basic Life Support (BLS)
- Certified Case Management certification preferred on date of hire and required to be completed within one year of hire.