The Division Director of Case Management fosters effective communications at all levels of the company and between all disciplines. The Division Director champions HCA strategy and company / division / facility initiatives to ensure short term and long term objectives are operationalized within assigned facilities.
The Division Director will provide engaged leadership to facility Executive Staff and facility Case Management Directors with Case Management and Utilization Management issues. The Division Director is a subject matter expert who serves as an internal consultant to multiple facilities and departments within the company. The Division Director identifies improvement opportunities and facilitates process standardization to promote improved outcomes, maximize resource utilization, and improve organizational efficiencies. This position is required to travel to and from locations within assigned geographic area.
- Provides leadership to and actively participates with facility staff to identify, implement, or enhance Case Management programs consistent with HCA and facility strategy
- Assesses Case Management and Utilization Management performance in assigned facilities
- Disseminates information accurately and timely with multiple audiences; leads regularly scheduled communication sessions with facility CM Directors
- Identifies process improvement opportunities; develops, implements, monitors and revises action plans
- Identifies and shares best demonstrated practices; stays abreast of current practice standards; shares within division and across company; facilitates standardization where appropriate
- Reviews existing policies and recommends revisions; assists with the development and subsequent implementation of new and/or revised policy and procedure; ensures compliance with all HCA policy and procedure
- Facilitates the implementation and adherence to regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives related to Case Management services
- Provides regulatory and compliance updates and initiates/drives process changes to ensure compliance with regulations and quality initiatives. Reports findings to appropriate corporate entities
- Provides data analysis of identified case management metrics; develops, implements and monitors action plans when benchmarks are not met; educates and mentors facility case management staff on interpretation of data and the performance of causal analysis; Reports findings to appropriate corporate entities
- Fosters communication and facilitates collaboration between facility Case Management and PAS as well as other departments within HCA
- Assesses learning needs related to case management practice
- Facilitates and assists with new and ongoing Case Management education within the division; provides or facilitates specific education related to the 4 critical functions of case management practice and process; focuses on case management, evidence-based, best-practice and regulatory compliance
- Ensures that all HCA-mandated education is completed within the set time frames
- Performs random open chart audits to validate that policy, procedure and standards are met; works with facility Director to develop action plans; works with Corporate Case Management and Regulatory Compliance teams prior to developing and implementing facility or division wide audits
- Provides input to managed care department on utilization management activities and communicates current contract information to facilities
- Provides leadership to the development of resource reduction strategies consistent with facility strategic plan within the areas of case management and utilization management with a focus on quality outcomes, reduction of length of stay, medical necessity and level of care
- Provides support and leadership in implementation and oversight of the case management aspects of ESP; monitors and reports monthly ESP metrics from the ED Dashboard
- Provides support and leadership in implementation and oversight of the case management aspects of the Bed Management program
- Designs, implements and monitors processes to ensure facility outcomes are achieved related to managed care contracts, ensuring that a process for obtaining appropriate authorizations or determinations of medical necessity for all payers is in place; facilitates contract compliance resulting in a decrease in payer denials and avoidable days at the facility level
- Anticipates and proposes opportunities to improve current technology or identify new technology to enhance performance and productivity: Leads initiatives in assigned facilities
- RN with current state licensure, BSN preferred
- 5 years Nursing Case Management experience
- 5 years leadership experience
- Certification in Case Management, Nursing, or Utilization Review, preferred
- Ability to establish and maintain collaborative and effective working relationships
- Ability to communicate effectively in oral, written and electronic formats
- Demonstrates analytical and critical thinking abilities with pro-active decision-making, problem solving and negotiation skills
- Bachelor degree required.
- 5 years hospital case management experience required.
- 2 years director/supervisor level experience
- CPUR, CCM preferred