What are the responsibilities and job description for the CASE MANAGER DIRECTOR- FULL TIME position at Sweeny Community Hospital?
Job Details
Description
Summary/Objective:
Case Management Director is responsible for coordinating and managing the Case Management Department. Ensures that the Case Management Department thoroughly vets all patients to determine the most accurate level of care and follows up with payers on authorizations and recertifications.
Essential Functions:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Monitoring case management and support staff activity to ensure that the case load is distributed appropriately.
- Provide back up to case management staff as needed.
- Ensure processes are in place to standardize case management services.
- Assist with the creation and implementation of policies and procedures regarding case management.
- Facilitate on-going communication between Case Management staff, patients, providers, and other involved entities.
- Compile and review multiple reports for tracking purposes to identify case management trends and assist in forecasting.
- Oversee and provide support, guidance and coaching to case management team and team leaders.
- Other duties as assigned
Competencies:
Communication proficiency
Ethical Conduct
Flexibility
Supervisory Responsibility:
This position has supervisory responsibilities.
Work Environment:
This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, fax machines, and other equipment as needed.
Physical Demands:
The physical demands described as follows are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk and hear. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. Duties regularly require standing, walking, bending, kneeling, stooping, pushing, pulling and crouching as well as lifting and/or moving up to 50 lbs.
Qualifications
Position Type/Expected Hours of Work
This is a full-time position, and core hours of work are Monday through Friday 8 hours per day with no overtime. Position requires work schedule flexibility based on needs of the facility.
TRAVEL
Occasional or frequent travel is expected for this position.
Required Education, Experience and License
Associate degree Registered Nurse
Ability to work with staff, physicians, and patients
Professional License as applicable or Texas Driver License if driving for SCH with an acceptable record
Preferred Experience
2 years working in a hospital setting
2 years working in healthcare Quality and Case Management preferred
Responsibilities:
Develops and implements systems and policies and procedures for the identification, collection and analysis of quality and performance measurement data.
Educates and trains staff in the quality improvement plan and performance improvement program and their responsibilities.
Coordinates Quality Management Committee meetings, assist QI assistant in recording minutes.
Assists the medical, nursing and other professional staff in the developing of Quality Assurance programs, monitors indicators of care and reviews criteria. Reviews quality assurance data and refers information to the appropriate committee, department, service or individual for information, use or action as indicated and prepares reports for
Administration.
Collects and summarizes performance data, identifies opportunities for improvement, and presents findings quarterly to the Quality Management Committee and CEO, Healthcare integration (HDI), CMS, Texas Safety Network (TSN) and other reporting entity.
Analyzes Press Ganey customer survey data to identify opportunities for improvement and presents findings to appropriate departments and Administration.
Participates on hospital committees as required or needed and assist in reporting in the Safety committee.
Manages the Rural Community Healthcare Network (RCHI) program and submits patient charts for review. Coordinates monthly with Medical Staff for Teleconference Peer Review.
Works with appropriate departments for submitting relevant data.
Manages the Hospital Department Initiatives with Risk Management/Patient Safety
Works with Nursing Service and Medical Records to submit quality data to TMF, HDI and other data bases as required.
Assist in initiating, training and set up of new systems as needed.
Performs root cause analysis as needed for near misses and adverse events.
Handles all grievances received from patient or legal guardian via email, fax, phone and /or in person.
Follows CMS request for handling grievances. Grievances are unresolved complaints and may also include grievances on patient satisfaction surveys only if a name is provided.
Attends monthly QAPI meetings at area Skilled Nursing Facilities and oversees their Quality Improvement initiatives.
AAP/EEO Statement
Sweeny Community Hospital provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.
