Director/Case Management/Care Transition

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!

We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South.

The Director of Case Management/Care Transitions leads a collaborative case management effort by coordinating the care and services of patient populations at the assigned facility. Provides clinical leadership for the care management team by serving as an educator, role model, patient advocate, and change agent to achieve optimal clinical, financial, and resource outcomes. Leads the Transitions of Care program for specific patient populations transitioning from inpatient to outpatient care. Oversees daily team activities and provides strong leadership through training, coaching, teaching and managing assigned teams. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence.

A Brief Overview

The Director of Case Management/Care Transitions leads a collaborative case management effort by coordinating the care and services of patient populations at the assigned facility. Provides clinical leadership for the care management team by serving as an educator, role model, patient advocate, and change agent to achieve optimal clinical, financial, and resource outcomes. Leads the Transitions of Care program for specific patient populations transitioning from inpatient to outpatient care. Oversees daily team activities and provides strong leadership through training, coaching, teaching and managing assigned teams. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What You Will Do

• Case Management
• Provides clinical guidance and supervision to all case management programs, based on accepted principles of nursing, social work, and case management practice.
• Provides leadership to the interdisciplinary team (RNs, APNs, Social Workers, Utilization Review) to achieve optimal outcomes through the tools of care management.
• Collaborates with stakeholders to continually streamline, standardize, and systematically implement best practice case management processes, including interfaces with revenue cycle.
• Develops and implements case management programs, including utilization review, intake, and discharge planning.
• Manages and monitors department activities to evaluate the productivity and quality of programs and processes in order to identify potential improvements and ensure maximum performance.
• Develops and administers budgets for operational areas, authorizes expenditures, and monitors budget and other financial indicators. Assists in the development and implementation of plans to control costs and improve department operations.
• Develops and maintains professional networks and relationships with hospitals, physicians, community resources, and other providers to promote continuity and quality of care.
• Uses a collaborative approach with physicians and the multidisciplinary team to facilitate care and eliminate barriers for the designated case load. Ensures that the plan of care and services provided are patient focused, high quality, efficient, and cost effective. Seeks care plans that balance clinical and financial concerns with the family’s needs and the patient’s quality of life.
• Uses data to drive decisions and plan/implement improvement strategies for assigned patients, including fiscal, clinical, and patient satisfaction data.
• Initiates and leads the development, implementation, evaluation, and revision of clinical pathways.
• Ensures that policies and procedures are developed and enforced in alignment with standards of patient care and regulatory bodies, and that the core components of case management processes are followed.
• Works in collaboration with other key stakeholders to remain current on regulatory requirements. Participates in the development of standardized processes to fulfill compliance with all CMS and regulatory agencies’ statutes/standards specific to utilization management.
• Directs or provides oversight for the activities of Associates reporting to this role; monitors Associates performance and clarifies work expectations, assists with goal setting, and promotes cooperation among individuals and groups. Develops and implements processes through orientation, training and education to ensure that the competence of all staff members is assessed, maintained, improved and demonstrated throughout their employment.
• Revenue Cycle
• Serves as a resource to the corporate and facility Revenue Cycle teams as well as Corporate Compliance for any/all denials including all pre and post pay audits related to utilization management. Serves as an active participant in the appeals process.
• Improves care transitions for complex patients to reduce readmission rates impacting reimbursement.
• Care Transition
• Directs the Transitions of Care program to coordinate and meet the complex needs of patients with chronic conditions and/or specific populations as they transition from hospital to home or different levels of care.
• Creates and oversees a high-quality program to focus on care transitions which include comprehensive discharge planning, timely communication of information between care providers, patient/caregiver education, medication reconciliation, and follow-up visits.
• Identifies specific readmission risks, and targets risk-specific interventions to identify barriers to discharge, reduce length of stay and readmission rates.
  
  

Education/Formal Training Requirements

• Master's Degree Nursing- RN
  
  

Work Experience Requirements

• Acute care environment
• 5-7 years General nursing or clinical practice
• 7-9 years Supervisory or Management
  
  

Licenses And Certifications Requirements

• BASIC LIFE SUPPORT - American Heart Association
• Accredited Case Manager (ACM) American Case Management Association Certification
• Case Manager - The Commission for Case Manager Certification
• Registered Nurse Arkansas - Arkansas State Board of Nursing
• Registered Nurse Mississippi - Mississippi Board of Nursing
• Registered Nurse Tennessee - Tennessee Board of Nursing
  
  

Knowledge, Skills And Abilities

• Working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
• Strong understanding of pre-acute and post-acute venues of care and post-acute community resources.
• Demonstrates advanced conflict resolution and problem solving skills for timely resolution of issues.
• Communicates clearly and professionally in both oral and written communication.
• Demonstrated ability to develop and maintain working relationships with physicians and work collaboratively with health professionals at all levels to achieve established goals.
• Knowledge of quality improvement tools and metrics to assess and manage case management goals.
• Understanding of regulatory/compliance requirements such as UM/URAC and CMS conditions of participation.
• Demonstrated excellent facilitation skills.
• Strong organizational and time management skills as evidenced by capacity to prioritize multiple tasks and roles.
• Intermediate to advanced computer skills; experienced with Microsoft Word and Excel. Knowledge of EMR systems and case management software and tools.
• Ability to use initiative in decision-making, independent judgment, and critical thinking skills.
  
  

Supervision Provided by this Position

• Manages all staff assigned to Case Management and Transitions of Care.
  
  

Physical Demands

• The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
• Must have good balance and coordination.
• The physical requirements of this position are: medium work - exerting up to 50 lbs. of force occasionally and/or up to 25 lbs. of force frequently.
• The Associate is required to have close visual acuity including color, depth perception, and field of vision to perform an activity, such as assessing patients, preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
• Occasional invasive and non-invasive patient contact.
• Exposure to patient body fluids as well as exposure to hazardous or poisonous materials.
• Ability to react quickly to emergency situations.
• Occasional travel to other facilities.
  
  

Our Associates are passionate about what they do, the service they provide and the patients they serve. We value family, team and a Power of One culture that requires commitment to the highest standards of care and unity.

Education

Master's Degree: Nursing- RN (Required)

Work Experience

Care coordination, case/care management, utilization/resource management, quality management or transitions of care, Clinical nursing, Supervisory or Management

Certifications

Accredited Case Manager - American Case Management Association, BASIC LIFE SUPPORT - American Heart Association, Case Manager - The Commission for Case Manager Certification, Registered Nurse Arkansas - Arkansas State Board of Nursing, Registered Nurse Mississippi - Mississippi Board of Nursing, Registered Nurse Tennessee - Tennessee Board of Nursing

Boasting one of the South's largest medical centers, Memphis blends a friendly community, a thriving and growing downtown, and a low cost of living. We see each day as a new opportunity to make a difference in the lives of the people in our community.