Case Management Director - RN or LCSW

Northeast Georgia Health System • Gainesville, GA

3d

About The Position

Coordinates the development and implementation of case management and social work services with an emphasis of vertical integration throughout the Northeast Georgia Health System delivery system. Organizationally responsible for case management, discharge planning, access control, continuum coordination, pre-certification for post acute services, resource management, and inpatient acute social work.

Requirements

• currently licensed as a RN or LCSW
• Bachelor’s Degree required, Master Degree required if Social Work candidate
• Five (5) or more years experience in hospital clinical/financial operations and management
• Experience in at least one major component of Case Management, i.e. Discharge Planning, Clinical Social Work; previous Case Manager
• Experience working with third party payers and Physicians
• Knowledgeable in operational design, assertiveness/persuasiveness, effective written/verbal communication, and ability to effect change
• Possesses positive relationship building, flexibility, problem solving, organizational skills, analytical skills, high level of emotional intelligence, and vision
• Must have knowledge of healthcare funding resources, patient services and clinical standards and outcomes

Nice To Haves

• Masters Degree preferred, i.e., Nursing, Business Health, Management, Leadership, Case Management, etc within 3 years if RN
• Experience in healthcare Federal and State regulations

Responsibilities

• Coordinates the operational design and collaborates to ensure an integrated case management and social work function.
• Develops and coordinates the implementation of the case management function from a systems perspective promoting an interdisciplinary collaborative proactive environment.
• Coordinates the development and implementation of case management education.
• Identifies opportunities and makes recommendations to improve NGHS services and to enhance continuum options.
• Works closely with senior management and the multi-disciplinary team to manage the delivery of patient services within given time frames, to decrease the length of stay for inpatient care, to ensure effective and prudent use of resources, and to improve care continuity and patient outcomes.
• Participates in length of stay system initiatives and is an active member of all LOS steering committees. This position is ultimately accountable for ensuring case management duties are fulfilled during IDTs (Interdisciplinary Team Meetings) and must round regularly and participate in IDTs to improve system Length of Stay.
• Works closely with Providers to better manage the process for admission, concurrent patient management, discharge and post discharge activities.
• Evaluates program structure and processes on a continuous basis to adapt program design to meet the demands of a changing healthcare system and organizational objectives.
• Provides for systematic patient management through effective use of NGHS continuum and maintains organizational responsibility for access control.
• Works with Providers to coordinate, develop and implement clinical process improvements.
• Works with Directors of Operations and Quality Improvement to analyze data for the purpose of identifying opportunities for clinical process improvements.
• Participates with Providers and NGMC internal staff to develop, implement and monitor the effectiveness of clinical pathways.
• Works with senior administration to resolve operational issues that are barriers to clinical process improvement endeavors.
• Participates in MRUR (Medical Record/Utilization Review Committee), including performing and updating on medical/clinical case studies.
• Explores opportunities and makes recommendations for organizational standards.
• Responsible for components of and strives to enhance/maintain NGHS financial performance improvement.
• Maintains accountability for timely pre-certification for Post Acute services and minimizes the organizational financial risk for penalty.
• Provides case-by-case contract negotiations for the organization, where indicated.
• Responsible for acute inpatient social work functions.
• Effectively and efficiently manages Case Management Department.
• Hires appropriate budgeted positions and assures proper training.
• Conducts regular, informative meetings with staff and responds to their needs.
• Performs performance appraisals in a timely and open manner.
• Maintains professional work ethics within the department and assures maximum staff productivity.
• Provides staff counseling and disciplinary action as necessary and/or required.
• Assesses departmental workload and determines appropriate staff allocations.
• Coordinates, monitors and manages outcome data to measure clinical and financial performance.
• Works closely with Providers and staff to provide, interrupt and monitor clinical/financial data for the purpose of improving hospital/Physician performance and anticipating payer and managed care demands.
• Maintains responsibility for tracking and reporting avoidable day.
• Demonstrates sensitivity to customer service data and develops appropriate strategies for response as indicated.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees