Job Summary The DIRECTOR CASE MANAGEMENT is accountable and responsible for departmental assessment, problem identification, budget, outcome monitoring and reporting, long term planning and evaluation of all operational aspects of the Clinical Resource Management and Social Services departments. Oversees clinical operations for managed care plan contracts including utilization management, case management, and social services. Responsibilities include directing the activities, performance and development of staff members and the development and evaluation of new processes and improvements.
The Director assumes responsibility and accountability for incorporating the vision, values, mission and critical goals of the organization into the Case Management Department and their own personal job performance.
Provides state of the art Case Management direction, including clinical and financial management at the patient level, to ensure the consistent high quality provision of care coordination, transitional planning and utilization management. Provides leadership and coordination of Case Management, working closely with the Chief Medical Officer and the Case Management Manager/Supervisor. Develops and ensures close working relationships internally with other system departments and physicians and externally with health plans, care facilities, agencies, other hospitals and vendors, as required. Utilizes data to make informed decisions related to the delivery and outcomes of Case Management, department productivity and staffing. Serves as a change agent for implementation of new programs and existing ones. Member of the Nursing Leadership Council.
Develops an environment that supports excellence in personalized patient case management and service by leading and directing implementation of the efficient movement of the patient through the continuum of care, utilizing Case Management principals of Care Coordination, Transition Planning and Utilization Management. Focus is placed on critical factors and evidence-based knowledge necessary to determine the patient's health functional status and psychosocial well-being. Assures management processes are in place to achieve the application of Case Management interventions necessary to meet timely effective patient discharges at the lowest cost, while maintaining quality of care, patient and family satisfaction and payor requirements Maintains sound financial practices that support the outcomes of the program and the financial goals of the organization.
Prepares and justifies annual operating and capital budgets based on projected department and system needs, department policies and goals, and system operational strategies.
Maintains personnel and other direct expenses within department budgetary expectations. Monitors monthly management reports and analyzes trends; takes action appropriately and in a timely manner.
Develops and implements cost containment strategies; educates department personnel on their role in controlling costs.
Evaluates contributing factors to budget variances and modifies fiscal management strategies as appropriate.
Establishes staffing patterns and time scheduling practices which facilitate the delivery of consistent and efficient clinical resource management, social worker services, clinical documentation, and translation/interpreting services.
Develops and maintains effective relationships with hospital departments providing support services. Monitors services provided and collaborates in developing methods to improve utilization and efficiency.
Fosters a collegial environment in which there is sharing of expertise with other professionals. Facilitates the observational or clinical experience of students within the department.
Maintains appropriate skills to perform strategic planning for the support of, or the development of, existing or new programs or services as required.
Demonstrates the ability to lead tactical planning in support of strategic planning skills.
Monitors DRG financial performance, identifies trends, and collaborates with medical staff leadership to achieve optimal financial performance.
Fosters collaborative partnerships that involve all disciplines within Case Management with medical staff and members of all related system departments, especially Nursing. Plays a leadership role with Case Management Managers/Supervisors and staff in developing and maintaining community relationships, including other patient care facilities, agencies, other hospitals, health plans and vendors, as required. Works closely with the Medical Director, Utilization Management, Nursing, the Chief Medical Officer and the AVP to optimize the Medical Director role internally and externally. Responsible for restructuring and changing processes within department to meet hospital, and system wide strategic plan and goals.
Oversees planning, coordination and development for utilization management, social services, and case management for managed care plans.
Utilization review is performed and processed in accordance with health plan provisions and local and federal regulations.
Develops policies and procedures for Clinical Resource Management and Social Services departments.
Develops, with the Chief Medical Officer and Executive staff, strategic metrics short and long range Utilization goals in line with Honorhealth system goals to achieve the necessary clinical and financial outcome measures identified. Assures the implementation, achievement and evaluation of the utilization goals and action plan of the system. annually through consistent monitoring. Develops internal processes and identifies process improvement needs.
Systems are evaluated to ensure quality and cost effectiveness.
Systems developed support Managed Care's strategic objectives.
Responsible for education of staff to current Medicare, AHCCCS rules and regulations.
Develops and evaluates strategies for excellence in patient, physician, employee and intra-departmental satisfaction. Responsible for the formulation and design of Case Management policies and participates in the formulation of policies, including strategies based on an awareness of consumer needs, market demands including payor requirements, compliance issues and quality care issues relevant to the health care system. Accountable for the ongoing evaluation of the multi-disciplinary collaborative process of Case Management and management of organization policies and procedures as they relate to the delivery of Case Management services. Manages department within organizational standards.
Maintains financial responsibility for department by developing budgets and ensuring compliance.
Ensures high quality and cost effective operations through a well-trained staff. 1.Develops, with the Case Management Managers/Supervisors, the annual capital and operational budgets for each facility. Accepts accountability for meeting budgetary goals.
Directs, manages and evaluates personnel, along with the Case Management Managers/Supervisors, assuring consistent monitoring of staff competence. Sets directions and provides oversight for recruitment and retention strategies. Along with the Case Management Managers/Supervisors, selects and hires personnel based on departmental budget, staffing plans and personnel needs. Assures the Case Management Managers/Supervisors implement a consistent departmental plan for orientation and ongoing evaluation of staff competencies. Promotes departmental climate of interdisciplinary team work, through the utilization of the strengths of all disciplines, intra-department collaboration, win-win decision-making, and personal accountability. Establishes and maintains collaborative working relationships with physicians and other hospital directors to support the mission, vision, values, and priorities of HonorHealth.
Serves as Clinical Liaison for managed care contracts and Medicare.
Relationships are developed and maintained with external contacts to assure quality service is provided.
Partners with medical staff to assure proper utilization of resources for hospitalized patients.
Rounds with Chief Medical Officer to identify opportunities for improvement in all aspects of Clinical Resource Management and Bed Utilization.
Reports outcome indicators for Clinical Resource Management and Social Services to Utilization Management Committee and Administration.
Facilitates and supports educational opportunities to provide innovative learning experiences for staff and students and create a culture of development that ensures a standard of competencies. Fosters collaborative relationships with educational and other external professional organizations. Maintains all regulatory education requirements. Participates in continuing education, quality improvement activities and supports membership and certification in professional organizations.
Assists in the development, implementation and monitoring of protocols, along with physicians and other departments. Demonstrates data-based decision-making skills and facilitates utilization to comply with State and Federal regulatory agencies, accreditation agencies, and other legal regulatory bodies. Supports service line initiatives to assure organizational and operational service line goals are met. Projects and plans for future program development, use of space, facilities and equipment for assigned areas. Performs other related duties as assigned or requested.
Maintains utilization review/discharge planning functions in accordance with accreditation licensure process.
Actively supports Utilization Review Committee.
Develops, maintains, and evaluates integrated systems that allow Clinical Resource Management and Social Service team to utilize Interqual criteria for hospitalized and outpatients.
Internal Number: 2018-9306
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Welcome to HonorHealth.
We are a non-profit, local healthcare organization known for community service and outstanding medical quality. Our organization encompasses five acute care hospitals with approximately 10,500 employees and 3,100 volunteers, urgent care centers, clinical research, medical education, an inpatient rehabilitation hospital, an Accountable Care Organization, two foundations, and extensive community services.