The director is responsible for maintaining operational and financial responsibility for the Case Management, Social Service and Patient Transport Departments. The director is responsible for hospital case management and social work services as well health care delivery system wide programs which involve transitions of care and efficient utilization of post-acute care. The director is responsible for the day-to-day operations of the physician clinical documentation program and is available to assist the physician coaches as needed. The director is responsible for the development of policies/procedures to enhance the department’s operations. The director will collect, assess, and analyze clinical and financial outcome data and report findings as necessary. The director is accountable and responsible for ensuring that each Case Manager and/or Social Worker is coordinating the care and service of selected patients with physicians, nurses and other members of the healthcare team to facilitate the plan of care. The director is also responsible for ensuring that each case manager places the patient in the appropriate level of care, monitors the utilization of healthcare resources, and participates in discharge planning to achieve desired clinical, financial, and resource utilization outcomes. Reports to: Chief Financial Officer and secondarily to the Chief Medical Officer. The Chief Nursing Officer is responsible for all nursing practice.

SHIFT AND SCHEDULE

Full Time: 8:00 AM – 5:00 PM

ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS

• Daily operations of the Case Management and Social Services Departments, clinical documentation program, and utilization of contracted ambulance services.
• Supervising the Case Management and Social Service staff and developing a viable schedule that meets the needs of each department and the organization.
• Establishing an adequate annual departmental operating and capital budget for Case Management and Social Services.
• Applying CQI principles to collect, assess, and analyze clinical and financial outcome data.
• Designing metrics to measure the interventions to determine the outcomes of the case management program.
• Reports that are professional in appearance, reflect an appropriate analysis of the data, and contain conclusions and action plans when appropriate.
• Meeting as needed with the Case Managers and Social Worker team, nursing, other healthcare personnel and / or patient and family members to discuss the patient’s plan of care.
• Managing the Care Coordination program with the ACO/Clinically Integrated Network for the organization.
• Assist with communication and coordination of care with Post-Acute Care (PAC) to assure appropriate utilization of resources for our patients and the healthcare system. Demonstrates:
• Well-developed interpersonal skills with patients, families, physicians, nursing colleagues, ancillary departments, and the case management team.
• Ability to prioritize projects appropriately and utilizes work time effectively.
• Critical thinking skills when making decisions and analyzing data that is congruent with the hospital’s strategic goals.
• Broad know ledge base of MS-DRG, ICD9/10, CPT codes, and (changing) health care reimbursement incentives by assuming responsibility for identifying and meeting own educational needs. Ensures that each Case Manager and Social Worker:
• Collects in-depth information about a patient’s situation and functioning, to identify those individual needs and develop a comprehensive case management plan that will address those needs.
• Determines time specific objectives, goals, and actions designed to meet the patient’s needs as identified through the assessment process.
• Executes specific case management activities and/or interventions that will lead to accomplishing the goals set forth in the case management plan.
• Organizes, integrates, and modifies the resources necessary to accomplish the goals established in the case management plan.
• Gathers sufficient information from all relevant sources about the case management plan and its activities and/or services to enable the case director to determine the plan’s effectiveness.
• Evaluates the case management plan’s effectiveness to reach desired outcomes that might lead to modification or change in the case management plan entirely or in any of its component parts.
• Respects patients’ rights, maintains confidential information and acts as a patient advocate in order to accomplish the case management plan.
• Conducts concurrent admission screening within 24 hours of admission or the next working day and concurrent continued stay reviews documenting the patient’s progress on a daily basis and identifying and addresses issues in a timely and efficient manner. Conferring with attending physician when appropriate to make a determination about medical necessity.
• Assists the Care Coordination manager with the responsibility of assuring efficient transitions of care and that targeted high risk patients are assisted in maximizing the likelihood of successful PAC experiences.

EDUCATION AND EXPERIENCE

• Bachelor’s degree preferred.
• Current State of Texas License as a Registered Nurse.
• Five years of direct patient care experience.
• Three years case management experience.
• Certified in Case Management by the CCMC or the ANCC is a plus.
• Proficient in Microsoft Word and Excel.

PHYSICAL REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to:

• Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.