The Lead, Case Management oversees the functions to coordinate, negotiate, procure services for, and manage the care of complex patients with all health team members throughout the facility for a patient population served range in age from 18 years to geriatric experiencing medically complex conditions, general medical-surgical conditions with rehabilitation and/or wound care needs.
The Lead, Case Management duties include:
Provides leadership and serves as a professional resource to ensure development of excellence within the department.
Coordinates the discharge planning process by assessing the patient's
post-hospital needs, implementing discharge planning, addressing needs of the patient/family & providing consultation to the entire health care team
Integrates Case Management within the hospital's primary functions, policies and procedures as well as standards of practice
Supervise, coordinates and reviews the work of assigned staff for a single business line
Acts as a liaison between telephonic and onsite case management
Participates in acccount support and management
Assures achievement of unit financial goals and customer service/satisfaction goals
Provides expert medical and product support to staff.
Perform additional duties assigned.
Ability to project a professional image.
Knowledge and experience with ICD9-CM Codes.
Knowledge of reimbursement under PPS system.
Possess in-depth knowledge of functions of the Case Management Department and performance improvement requirements as outlined by JCAHO, the Department of Health for the State of employment and Federal regulatory standards as outline by Centers for Medicare and Medicaid (CMS)
Knowledge of hospital policies and procedures.
Working knowledge and ability to apply professional standards of practice in job situations.
Strong organizational and analytical skills. Demonstrates critical thinking skills.
Working knowledge of computer and software applications used in job functions. (order entry, data entry)
Persons who have been found guilty by a court of law of abusing, neglecting, or mistreating individuals in a health care related setting are ineligible for employment in this position.
Freedom from illegal use of drugs.
Freedom from use of and effects of use of drugs and alcohol in the workplace.
Education and/or Experience:
Graduation from an accredited school of nursing with a BSN or may substitute five (5) or more years experience as senior management in health care field for degree.
Five (5) years experience in acute hospital case management, health care provider, or managed care company.
Master's preparation is preferred.
Certificates, Licenses, Registrations:
A Registered Nurse who is currently licensed to practice by the state of employment is required. CCM Highly preferred. CPR certification preferred.