Large healthcare client is looking to bring in an interim Case Management Director to help with assigned departments and functions across the area continuum of care to provide integrated services in a fiscally responsible manner through direction, support, and development of administrative staff, and community groups and agencies. In addition, individual will be responsible for providing development and delivery of a Case Management system that utilizes best practices in the areas of pre-admission, registration, utilization management, discharge planning, case management, and social services. The position also ensures that patients receive timely and appropriate care during their hospitalization, for identifying delays in treatment, and for targeting opportunities to improve or enhance resource utilization. Additionally, the position is accountable for ensuring timely discharge through early intervention and identification of post hospital care needs, as well as ensuring continuity of care needs are met.
Essential Functions:
Knowledge/Skills:
Knowledge of requirements and eligibility parameters for payers, MediCal, and Medicare
Knowledge of IPA's
Knowledge of Epic EMR system
Knowledge of third party payer billing and managed care requirements
Knowledge of the Joint Commision and Public Health licensing requirements
Leadership skills consistent with the mission, vision, and values of the Health System
General knowledge of illnesses, current treatments, and their physical and psychosocial sequelae
Knowledge of applicable laws and regulations, government, and insurance benefits
Knowledge of utilization review process, discharge planning process, use of best practice guidelines and pathways
Knowledge of statistical data collection techniques and methods of analyzing and reporting statistical data
Demonstrated leadership skills, including facilitating teamwork, coaching, consensus-building and problem-solving
Strong foundation of clinical assessment skills necessary to provide care management for clients with highly complex medical, emotional, and social needs
Improve Performance:
Strengthens focus on excellence in a culture that measures quality and continues improvement of performance to meet the needs and expectation of patients and community
Assures that organizational and department policies and procedures are current, appropriate, and followed consistently
Assures a safe and efficient work environment for employees, assures quality improvement processes are effectively monitoring quality of services and lead to strategies for further improvement
Creates excellence in how customers are served both internally and externally with staff, works proactively to resolve complex problems in a timely manner
Follows the performance improvement process, including regular dialogue and feedback with employees about goals, responsibilities, expectations, and performance
Facilitates implementation of new technology, products, and supplies to provide safe, effective services and maximize productivity
Models and encourages a spirit of service in the organization (i.e. coordination and delivery of patient care that responds to patient and family needs, physical, physiological, spiritual, and social needs; interdisciplinary QI activities, participation in committees and PI teams)
Understands and helps others integrate the mission, vision, and values to the strategic goals and operations.
Communication:
Has been in previous leadership position and can effectively mentor counterparts
Clearly communicates the strategic initiatives and direction of the Health system, the region, the area, and the ministry
Acts as a liaison by effectively involving Medical staff, other departments, and stakeholders
Maintains accessibility for 1:1 communication with staff and provides avenues for appropriate follow up with employees
Utilizes team building strategies to promote positive relationships for a cohesive tea
Openly discusses issues and supports difficult decisions
Fiscal Stewardship
Assumes responsibility and accountability for fiscal management of assigned departments across all entities in collaboration with staff and physicians
Formulates, presents, and defends annual budget (including personnel, supplies, resources, and space) based on assessments of departments resources, programs, and projected needs
Analyzes trends and identifies opportunities to improve efficiency and productivity and decrease costs
Implements changes in systems, equipment, and technology to increase efficiency and productivity and to promote cost containment
Competency
Holds self and staff accountable for excellence in performance
Assures timely assessment of employee performance
Identifies and assures resolution of discrepancies between performance standards through coaching, feedback, and use of the progressive disciplinary process
Establishes processes to listen and respond to employees concerns, grievances, and suggestions
Planning
Initiatives strategic, operational, and programmatic plans/policies to achieve mission and area by vision by providing efficient and effective services
Encourages ideas, suggestions, and participation of others and involves others in planning, decision-making, and assessment processes
Performs periodic follow-up to assure actual implementation of changes and their effect on the organization
Identifies and fulfills educational and developmental needs and keeps updated on advances related to responsibilities