Director of Case Management

Surgery Partners Careers•Lubbock, TX

16h•Onsite

About The Position

We are looking for a dedicated Director of Case Management to join our Lubbock Heart team. This role plans, directs, implements, and monitors hospital-wide efforts to ensure appropriate level of care and psychosocial interventions. The Director serves as a liaison for the hospital with medical staff, hospital departments, regulator and extra review agencies, third party payers, financial services, and community health and welfare services. This role coordinates programs among departments, ensures services according to appropriateness of care, appropriateness of admissions and continued hospitalizations, monitors length of stay, observation status utilization, delays in discharges or care, case mix index, and other reimbursement/financial indicators to recommend and implement hospital-wide improvement strategies. The Director performs concurrent reviews for patients to ensure extended stays are medically justified and documented, refers cases not meeting guidelines to the Utilization Review Physician Advisor(s), and assists in patient facilitation through daily bed management meetings and multi-disciplinary activities. The Director participates in the development of effective hospital-wide Care Management strategies, ensuring compliance with external accrediting agencies and patient care review requirements. They ensure compliance regarding resource allocation, discharge planning, and social work intervention processes in accordance with regulatory agencies (DOH, CMS, etc.) and acts as a liaison. The Director serves as a change agent for program implementation, works independently, and coordinates patient care using an interdisciplinary approach across the continuum of care. They help develop and utilize medical guidelines for high-quality, cost-effective care, and use data for informed decisions related to Case Management delivery, outcomes, productivity, and staffing. The Director assesses needs, plans, communicates, and designs services appropriate to the hospital mission and patient/family needs, compiles monthly reports for the Utilization Review Committee, integrates and coordinates services using continuous quality improvement tools, maintains a positive work environment, adheres to budgets, ensures timely performance evaluations, completes departmental orientation and competency reviews, ensures valid licensure/credentials, and updates job descriptions. Additional duties may be assigned.

Requirements

3 – 5 years’ experience in a hospital setting as a case manager with utilization review experience
Licensed as an RN in the state of Texas, BCLS.

Nice To Haves

Certification as a Case Manager preferred
BSN preferred
Prior supervisory experience preferred

Responsibilities

Plans, directs, implements and monitors hospital-wide efforts to ensure appropriate level of care and psychosocial interventions.
Serves as a liaison for the hospital with medical staff, hospital departments and services, regulator and extra review agencies, third party payers, financial services and community health and welfare services.
Coordinates programs among departments and ensures services according to the appropriateness of care, appropriateness of admissions and continued hospitalizations, monitors length of stay, observation status utilization, delays in discharges or care, case mix index and other reimbursement/financial indicators in order to recommend and implement hospital-wide improvement strategies.
Performs concurrent reviews for patients to ensure that extended stays are medically justified and documented in patient’s medical records.
Refers to the Utilization Review Physician Advisor (s) all cases that do not meet established guidelines for admission or continued stay.
Assists in patient facilitation through participation in daily bed management meetings and implementation of multi-disciplinary activities to improve quality of care.
Participates in the development of effective hospital-wide Care Management strategies, ensuring compliance with external accrediting agencies and patient care review requirements.
Ensures compliance regarding resource allocation, discharge planning and social work intervention processes in accordance with regulatory agencies including but not limited to DOH, CMS, etc., and other authority, and acts as a liaison of the same.
Serves as a change agent for implementation of new programs and existing ones.
Works independently and provides and coordinates patient care using an interdisciplinary approach encompassing the entire continuum of care which may include outpatient, inpatient and post hospital services.
Helps to develop and utilizes medical guidelines in an effort to provide high quality, cost effective care sensitive to the resources available.
Utilizes data to make informed decisions related to the delivery and outcomes of Case Management, department productivity and staffing.
Assesses needs and plans, communicates and designs services that are appropriate to the hospital mission and patient/family needs.
Complies monthly reports and statistics to the Utilization Review Committee.
Integrates and coordinates services using continuous quality improvement tools.
Maintains a positive work environment for staff and physicians and promotes team efforts.
Adheres to established departmental operation and salary budgets, and provides explanations of budget variances.
Ensures performance evaluations are current and are reviewed by employees and completed timely.
Completes initial departmental orientation and competency review for newly hired employees.
Ensures that all licensure/credentials certificates for applicable personnel are valid and up to date.
Updates and maintains job descriptions for each job classification in accordance with hospital policy and procedures.
Additional duties as assigned