Director of Case Management
Company: Texas Nursing Services
Location: Austin
Posted on: March 19, 2023
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Job Description:
Job SummaryThe Director of Case Management is responsible for
the day to day operations of the department. The Director will
develop, implement, and review the Utilization Management Plan
annually. The Director is responsible for coordinating and
facilitating multiple resources, internal and external, into a
unique and single approach to care coordination for each patient
assigned case management services. The Director will identify and
implement processes that support and promote efficient patient
throughput across the healthcare continuum resulting in optimal
clinical outcomes, appropriate utilization of resources, and
appropriate and accurate reimbursement. The Director will provide
leadership, communication, and supervision to the department staff
to ensure HCA and facility strategy is operationalized.Participates
in providing patient specific care standards as directed, and
follows service excellence standards to ensure high levels of
patient satisfaction.You will demonstrate leadership,
collaboration, and effective communication skills in directing and
managing the assigned fiscal and human resources in support of
facility goals and objectives: establishes and communicates
department goals and objectives; manages personnel and assesses
staff accountabilities; care coordination; resource management;
discharge planning; utilization management; department productivity
targets; employee, patient and physician satisfaction;You will
identify and implement resource reduction strategies consistent
with facility strategic plan with a focus on quality outcomes,
reduction of length of stay, medical necessity and level of careYou
will develop, implement, and review the Utilization Management Plan
annually: holds self and others accountable for successfully
achieving approved plans; develops, monitors, and review action
plans.You will identify and champion new programs, system
processes, and company initiatives which improve clinical and
financial outcomesYou will direct department activities to minimize
account denials, opportunity days and variances in length of stay;
works collaboratively with colleagues to ensure resources are
optimizedYou will perform data analysis related to Case Management
metrics; develop, implement and monitor action plans related to
denials, avoidable days, LOS, QIO data (PEPPER reports, et al), and
other identified case management metricsYou will provide feedback
to Division Case Management Director on issues related to
department operations: offer input to Division Director on managed
care contracting issues; best demonstrated practices; process
improvement and utilization management activities; barriers to
achieving goals and objectives of initiatives; participate in HCA
Case Management and Division initiativesYou will demonstrate a
commitment to teamwork and cooperation; communicate accurate
information timely; collaborate with Physician Advisor; integrate
case management, social services, utilization management, and
discharge planning activitiesYou will proceed on Director's
initiative, in compliance with HCA standards, professional
standards of practice and policy and procedure, to resolve
identified issuesYou will direct activities to identify and provide
for the needs of the under resourced patient population to include
patient education activities, patient assistance programs, and
community based resourcesYou will develop and revise, implement,
monitor, and evaluate processes to ensure outcomes are achieved
related to managed care contracts; appropriate authorizations or
determinations of medical necessity for all payers sources are
obtained and documentedYou will initiate and facilitate
collaboration with hospital staff, PAS, managed care with a goal of
contract compliance and decreasing payer denials or non-medically
necessary days at the facility levelYou will collaborate with
physician advisor and medical staff to ensure quality outcomes and
patient throughput are maximized while supporting a balance of
optimal care and appropriate resource utilization.You will provide
leadership to and actively participate with facility staff to
identify, implement, or enhance Case Management programs consistent
with HCA and facility strategyYou will implement and monitor
regulatory requirements, HCA Ethics and Compliance policies, and
quality initiatives related to Case Management services; provide
regulatory and compliance updates to staff, provide standards of
practice updates, initiates / drives process changes to ensure
compliance to such regulations and quality initiatives as it
relates to Case ManagementYou will perform staff supervision to
validate policy, procedure and standards are met; collaborate with
Division Director prior to performing wide-spread records auditsYou
will assess learning needs of social worker and case managers:
provide for on-going educational needsYou will oversee utilization
management committee functions and effectivesYou will coordinate
department functions to ensure proper coding for the billing of
provider liable claims with the PAS, HIM and Nurse Auditor -Shift:
Full-time --- Days 7-10 Hrs/Wkdays OnlyJob Qualifications
Keywords: Texas Nursing Services, Austin , Director of Case Management, Executive , Austin, Texas
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