GENERAL SUMMARY OF DUTIES – The Director of Case Management’s primary responsibilities include: The manager of case management is responsible and accountable for the implementation of the case management program at the hospital level. The components/roles of the inpatient case management program consist of the following: care facilitation, utilization management, case management, and discharge planning.
SUPERVISES – Case Managers and Social Workers
DUTIES INCLUDE BUT ARE NOT LIMITED TO
- Provide leadership, education, and supervision for the day-to-day workflow of Case Managers and Social Workers.
- Monitor Case Management Department’s documentation to ensure it meets regulatory compliance.
- Collaborate with Chief Financial Officer and Quality Department to develop and maintain quality improvement programs and trending of data (e.g. Avoidable Days, Readmissions).
- Maintain skills in case management and utilization review to allow for coverage of patient caseload to cover staffing needs of all areas of the hospital.
- Communicate with physicians concerning patient needs and aid with the development of appropriate plans of treatment and assist with level of care and bed placement assignments.
- Directly responsible for personnel actions including hiring, performance appraisals, employee schedules, and maintain payroll records and time reports in KRONOS.
- Facilitate daily Multidisciplinary Rounds to provide collaboration with other disciplines to provide holistic patient care.
- Participate in discharge planning. Provide necessary education and resources to meet the discharge needs of individual patients and families.
- Active participant of Utilization Review Committee and Revenue Recycle Committee.
- Promote efficient utilization of clinical resources.
- Promote the appropriate amount of resources used based on patient acuity.
- Assure appropriate level of understanding, awareness, and compliance with all applicable Joint Commission, CMS, state and local agency laws, internal/external regulations, guidelines, policies, procedures, and professional standards.
- Other duties as assigned.
KNOWLEDGE, SKILLS & ABILITIES
- Working knowledge of payer requirements and discharge planning regulations that support the development of departmental policies, procedures, and standards.
- Working knowledge of Medicare, managed care, inpatient, outpatient, and home health continuum, as well as utilization management, discharge planning, and case management.
- Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.
- Working knowledge of concepts associated with performance improvement.
- Self-motivated, proven communication skills, assertive, able to work independently and as a team member.
- Demonstrated effective working relationships with physicians.
EDUCATION
- Graduate of a program of Registered Nursing.
- Bachelor of Science in Nursing degree preferred.
EXPERIENCE
- Minimum of two years of Case Management experience in utilization management, case management, discharge planning, or other cost/quality management programs.
- Two to three years previous management experience is preferred with a minimum of two years’ experience in hospital-based nursing.
CERTIFICATE/LICENSE
- Iowa Mandatory Reporter – Child and Dependent Adult Abuse Certificates.
- Current RN license in the state of Iowa or a multistate license allowing work in the state of Iowa.
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