BASIC FUNCTION: The Director of Case Management is responsible and accountable for the implementation of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, Utilization Management, Case Management and Discharge Planning.
The Director is responsible for developing systems and processes for care/utilization management and discharge planning at the hospital level. In addition, the Director may be responsible for managing the department’s activities related to discharge planning and clinical quality improvement. The Director evaluates and ensures that hospital resources are used appropriately and effectively. The Director oversees the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement. The Director promotes interdisciplinary collaboration, fosters teamwork and champions service excellence.
Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the patient served. Must demonstrate knowledge of the principles of growth and development as it relates to the different life cycles. Specific age groups that are served by this position are circled.
1. BSN or equivalent academic credit requirements for a BSN, clinical education and experience required. Master’s degree or equivalent experience preferred.
2. Minimum five years experience in utilization management, case management, discharge planning or other cost/quality management program.
3. Minimum five years experience in utilization management, case management, discharge planning or other cost/quality management program.
4. Three to five years experience in hospital-based nursing.
5. Knowledge of leading practice in clinical care and payor requirements.
6. Self-motivated, proven communication skills, assertive.
7. Background in business planning, and targeted outcomes.
8. Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management.
9. Working knowledge of the concepts associated with Performance Improvement.
10. Demonstrated effective working relationship with physicians.
11. Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.
12. Demonstrates commitment to the Partners-in-Caring process and the Behavioral Expectations in all interactions and in performing all job duties. Performs duties in a manner to promote quality patient care and customer service/satisfaction, while promoting safety, cost efficiency, and a commitment to the CQI process.
1. Plans, directs and supervises all aspects of the local level program.
2. Facilitates growth and development of the case management program consistent with enterprise wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed.
3. Responsible for approving and managing the day to day local level operational budget.
4. Responsible for identifying and achieving optimal targeted financial outcomes via the inpatient case management process.
5. Responsible for departmental personnel functions (hiring, firing, etc.) in conjunction with the Executive Director of Medical Management.
6. Writes and conducts annual and interim performance appraisal reviews for the professional and non-professional staff in department.
7. Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospitalists, community care managers, nurses, community resources, etc.)
8. Responsible for leading a high performance team of “system thinkers” who incorporate leadership principles and vision in performing the functions of case management.
9. Uses data to drive decisions, plan, and implement performance improvement strategies for case management.
10. Responsible for overseeing the education of physicians, managers, staff, patients and families related to the case management process at the local level. Participates in this evolutionary process by constantly identify future needs of current customers and/or identifying potential new customers.
11. Ensures safe care to patients adhering to policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
12. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.