Director of Case Management

CHS (Community Health Systems)   •  

Cedar Park, TX

Industry: Healthcare


8 - 10 years

Posted 166 days ago

This job is no longer available.

Position Overview


The Director of Case Management servesas an interdisciplinary team member to coordinate the delivery of health careservices leading to quality outcomes for the inpatient hospital population andtheir families with the limits of the financial and social resources availableto the patient and his/her family. The Director is responsible for the overallcase management program, including quarterly reports, appeals and denials,Utilization Review Committee and the facilitation of all case managers


General Duties

  • Applies standard admission criteria todetermine necessity of admission and level of care
  • Completes initial discharge planningassessment
  • Collects data in an ongoing manner and evaluatespatient's progress
  • Documents appropriate information thatis timely, accurate, and concise
  • Supports patient/SO learning needs andimplements appropriate measures
  • Involves patient/family/SO in plan ofcare and ensures timely & appropriate transfer to the next level of care
  • Coordinates with HIM, BO, & patientregistration in review decisions, discharge planning and fiscal communications
  • Maintains personal, financial andmedical information as confidential
  • Obtain targeted Medicare or self-pay LOSgoals
  • Eliminate in-patient denials
  • Reduce number of Transfer DRG's
  • Reduce avoidable days
  • Performs additional duties as assigned


Leadership Duties

  • Demonstrates creativity, intelligence,and discretion in planning, organizing and coordinating department functions
  • Assesses a situation, considersalternatives, and chooses the appropriate course of action
  • Completes employee evaluations in atimely manner and assess staff competencies on an ongoing basis
  • Demonstrates proficiency at hospitalwide and/or department specific computer software and technology
  • Demonstrates fiscal accountability fordepartment resources and the ability to achieve outcome within allocatedresources
  • Communicates and supports the hospital'smission, vision, and values, as well as departmental goals to all staff
  • Defines performance objectives andmetrics for the department
  • Collaborates with other departments toproblem solve ongoing issues that impact department/organizations goals and/orpatient care delivery
  • Incorporates quality improvement dataand/or patient satisfaction data into departmental goals
  • Ensures accurate and timely reporting ofdepartment payroll

Job Requirements

  • Bachelor of Science Degree in Nursing(BSN) required. Master's Degree in Nursing (MSN) or Masters in related field preferred
  • Current license to practice as aRegistered Nurse in Texas, or current license with a compact state
  • American Heart Association (AHA)approved Basic Life Support (BLS) certification required upon hire
  • CCM or CMC preferred
  • Minimum of ten (10) years of clinicalexperience as a Case Manager in an acute care setting, with at least three (3)years in a supervisory position
  • Knowledge of Federal and Staterequirements: HCFA, Medicare, Champus, Medicaid, Managed Care, and knowledge ofJCAHO guidelines desired
  • Strong needs assessment, utilizationreview and discharge planning experience
  • Solid understanding of reimbursementstructures and CMS regulations in the acute care setting required