Director Case Management

Glenwood Regional Medical Center•West Monroe, LA

About The Position

Responsible for the direction of staff and fiscal resources of the Case Management Dept. Oversight of the hospital Case Management program. Provides direction and planning for physician advisor, and staff to establish priorities identifying trends. Develop short- and long-term goals for cost containment and reduction of LOS and utilization of hospital resources. Develops structures and processes to facilitate participation by physicians, pharmacists, nurses, Social Workers and other health professionals in multidisciplinary care planning, care delivery, and discharge planning. Directs utilization review activities for the hospital, interfacing with external payers and review companies to determine appropriate medical necessity of admissions and continued hospitalization. Resolves conflicts related to discharge planning with patients/families, external agencies and payers. Facilitates transition of patients/families across the continuum by establishing relationships with appropriate providers and community services. Ensures compliance with DNV standards for the Continuity of Care function. Participates as a member of DNV Task Force. Establishes effective relationships with external agencies providing services to the organization (such as vendors, care providers, etc.). Effectively audits and monitors areas of responsibility for compliance issues. Promptly follows up on compliance issues. Creates an environment that encourages staff to report/resolve complicated issues. Employee is dependable and completes other assigned duties on schedule and these duties do not have to be redone.

Requirements

Must be a graduate of an Accredited School of Nursing with a current La State Board License.
A current Louisiana license is required.

Nice To Haves

RN Case Management experience in an acute care setting preferred.
Previous supervisory experience preferred.
Computer skills preferred.

Responsibilities

Provide direction and planning for physician advisor, and staff to establish priorities identifying trends.
Develop short- and long-term goals for cost containment and reduction of LOS and utilization of hospital resources.
Develop structures and processes to facilitate participation by physicians, pharmacists, nurses, Social Workers and other health professionals in multidisciplinary care planning, care delivery, and discharge planning.
Direct utilization review activities for the hospital, interfacing with external payers and review companies to determine appropriate medical necessity of admissions and continued hospitalization.
Resolve conflicts related to discharge planning with patients/families, external agencies and payers.
Facilitate transition of patients/families across the continuum by establishing relationships with appropriate providers and community services.
Ensure compliance with DNV standards for the Continuity of Care function.
Participate as a member of DNV Task Force.
Establish effective relationships with external agencies providing services to the organization (such as vendors, care providers, etc.).
Effectively audit and monitor areas of responsibility for compliance issues.
Promptly follow up on compliance issues.
Create an environment that encourages staff to report/resolve complicated issues.
Complete other assigned duties on schedule and ensure these duties do not have to be redone.