Manager of Case Mgmt

Job Description

Job Description

SUMMARY :

The Manager coordinates the care of the patients across the continuum of care. Responsible for addressing CDI, utilization management, and discharge planning activities to optimize patient outcomes within appropriate time frames. Facilitates the proper use of resources. Assists the director in the development and coordination of the CDI program and Case Management. Maintains compliance with regulatory standards within the scope of CDI and Case Management. Responsibilities include Outcomes Management, Utilization Management, Reporting / Data Analysis and Staff Management.

ESSENTIAL FUNCTIONS :

• Assists with the coordination of staff orientations and training programs. Documents and assesses effectiveness of staff training and reports findings to the Director of CM.
• Establishes and presents educational programs designed to educate and inform members of the Medical Staff and Nursing personnel on CDI and other Case Management initiatives.
• Monitors individual staff caseloads and beneficiary treatment plans to ensure effective delivery of care, productivity and timeliness within scope of practice in compliance with Department protocols.
• Develops staff performance evaluations in collaboration with Director of Case Management.
• Develops Case Management and CDI reports to Monitor Departmental outcomes, trends and issues and submits those reports to the Director of Case Management.
• Collaborates with medical providers, the Director and Nursing Leadership, on program interpretation and guidance.
• Revises operational processes, policies and procedures to ensure overall program effectiveness.
• Participate in weekly staffing meetings with Clinicians, Case Managers, Case Coordinator, and other PMHD staff.
• Conducts weekly meetings with the HIM coders to review and resolve differences in coding interpretations prior to the billing period.
• Meets with the Director of Case management regularly to update the Director of CM on all Case Management and CDI initiatives and Activities.
• Performs other duties and assumes other responsibilities as assigned by the Director of Case Management including a case load as needed by the department (as assigned).

OTHER RESPONSIBILITIES :

Other duties as assigned from time to time.

SUPERVISORY RESPONSIBILITIES :

Assumes responsibility for direct supervision of the case management Department in absence of the Director.

EDUCATION, KNOWLEDGE, SKILLS, ABILITIES, AND EXPERIENCE :

LICENSES AND CERTIFICATIONS :

AGE OF POPULATION SERVED :

Newborn  Infant / Pediatric  Adolescent  Adult  Geriatric  All  No Patient Care X