Responsible for the development, administration, education, and on-going evaluation of the Case Management department in accordance with the goals and objectives of Roger Williams Medical Center, Our Lady of Fatima Hospital, and external agencies. Oversees the five main functions of the department: 1. Patient advocacy, 2. Utilization Review, 3. Resource Management (adherence to evidence based medicine, utilization of resources); 4. Managing the Continuum of Care (discharge assessment discharge, planning, discharge placement, psychosocial intervention, financial intervention, quality improvement); 5. Clinical Documentation Management. Provides leadership and management for the Registered Nurses and Master's prepared Social Workers. The director is responsible for the effective functioning, education, program development quality improvement and coordination of the Case Management process to ensure that opportunities for improvement are identified, communicated and/or acted upon by appropriate individuals and groups. Also responsible for assuring appropriate financial reimbursement through use of utilization principles, appeals, and monitoring and budget for the department. Acts as a liaison with other departments, providers, insurance companies and referral sources. Develops processes to encourage seamless systems that provide effective, efficient and cost containment functions of the department. Collects, analyses and presents data to monitor, trend and develop interventions and appropriate action plans.
EDUCATION: Registered Nurse – licensed in the state of Rhode Island. BSN and Master's Degree required. Certification preferred.
EXPERIENCE: Minimum of 5years clinical experience in an acute care medical/surgical setting required, 8 years highly preferred. Home Care, Utilization Review, Discharge Planning, Quality Improvement and financial reimbursement experiencerequired. Minimum of 5 years in a progressive leadership position in the health care industry. Strong critical thinking skills. Working knowledge of statistics and various levels of patient care, i.e. hospital level of care, subacute, hospice, etc.