Director of Case Management

DEPARTMENT: CASE MANAGEMENT

FACILITY: Tift Regional Medical Center

WORK TYPE: Full Time

SHIFT: Daytime

SUMMARY:

The Director of Case Management directs and coordinates TRMC Utilization/Case Management and Discharge Planning activities, according to state and federal regulations, accrediting agencies, policy and procedures and in conjunction with insurance and third-party payor criteria. The Director also monitors, evaulates, and makes recommendations for TRMC improvements in resource management and managed care activities. In addition, he/she formulates, reviews, and revises policies and procedures to reflect current activities for all areas, revises hospital utilization management plans, supports and participates in hospital-wide performance improvement activities, coordinates data collections as requested, and provides feedback to appropriate departments, as well as maintains files of department activities and develops reports.

RESPONSIBILITIES:

• Maintains and increases current knowledge of Utilization/Case Management, managed care advances, federal payor programs, insurance companies, current JCAHO standards, Documentation Improvement activities, Patient Education and Discharge Planning resources and advances.
• Directs and coordinates Case Management Department in accordance with the Medical Center's mission/vision, administrative policies/procedures and state, federal and accrediting agency guidelines.
• Formulates and disseminates Case Management departmental policies and procedures as well as all TRMC wide Discharge Planning and Utilization Review administrative policies and procedures.
• Directs departmental Performance Improvement activities, including meeting schedules, PI Committee reports, educational sessions, and team activities.
• Directs TRMC- Documentation Improvement, Discharge Planning and Utilization/Case Management activities.
• Maintains files and documentation on activities for all responsible duties.
• Supports and participates with other departments in review and revision of Performance Improvement plans/activities and Medical Center-wide patient education plans/activities.
• Supports and participates in TRMC-wide Performance Improvement educational opportunities. Provides departmental, individual and team educational opportunities and programs relating to Performance Improvement activities, principles of team improvement, documentation, and reporting requirements as requested.
• Monitors and evaluates improvements in level of TRMC personnel understanding of documentation improvement activities. Ensures that actions are taken to continually improve staff understanding of improving services, systems and processes that directly or indirectly affect patient care and other services provided by the Medical Center.
• Monitors and evaluates the TRMC-wide Discharge Planning, and Utilization/Case Management programs. Ensures that actions are taken to continually improve all services.
• Collaborates and communicates with administration, physicians, TRMC departments, Medical Center personnel, community resources and payors regarding changes in Utilization/Case Management regulations, managed care activities.
• Directs, evaluates and facilitates improvements in the Case Management Department employee performance and maintains departmental personnel files.
• Chooses the appropriate time and place to discuss TRMC business with the staff.
• Conducts an annual performance evaluation on each employee by October 1 fiscal year.
• Displays and promotes a high degree of integrity and honesty by insuring appropriate and timely communication of work-related information to department staff, administrative staff, and other managers so as to facilitate work flow and the decision-making process.
• Creates an environment that is non-threatening, that promotes innovation and reasonable risk-taking, and makes employees feel that TRMC cares for them.
• Encourages employees to make decisions at the lowest possible level commensurate with their authority, realizing that every decision may not be the one he/she would have made.
• Makes decisions commensurate with his/her authority and does not pass it up to the next level of management.
• Solicits input and opinions from employees by demonstrating good listening skills.
• Praises employees in public and punishes in private, not intentionally embarrassing or belittling anyone.
• Consistently and fairly applies personnel and TRMC policies and procedures and assures that they are clearly communicated to employees.
• Intervenes and counsels employees in a timely manner regarding performance and disciplinary matters, fully documenting such occurrences according to TRMC guidelines.
• Demonstrates proper skill in the interviewing and selection of staff for the department.
• Observes the quality of work being performed in the department and intervenes when appropriate to correct or enhance the quality of work being offered.
• Demonstrates the consistent use of participative communication and problem-solving skills in department and staff meetings.
• Demonstrates the ability to evaluate the performance of other staff members against the criteria stated in their job descriptions.
• Structures day-to-day tasks, objectives, and work flow in the department's operation so that priorities are established and time frames are met.
• Keeps abreast of all pertinent federal, state and facility regulations, laws and policies as they presently exist and as they change or are modified.
• Ensures that the staff are trained and evaluated on their knowledge of and adherence to compliance policies and procedures specific to their jobs.
• Demonstrates the ability to perform tasks that meet the age-specific requirements of the persons, patients, vendors, and staff that the employee is charged to interact with as required by the position.
• Offers suggestions on ways to improve operations of department and reduce costs.
• Attends all mandatory education programs.
• Improves self-knowledge through voluntarily attending continuing education/certification classes.
• Maintains required competency levels as identified in written exams, skills checklists, skills labs, annual safety and health requirements as well as service excellence education hours requirements.
• Cross-trains in order to better assist co-workers and to provide maximum efficiency in the department.
• Volunteers/participates on hospital committees, functions, and department projects.
• Manages resources effectively.
• Reports equipment in need of repair in order to extend life of equipment and removes malfunctioning equipment out of service with timely reporting to the appropriate personnel.
• Makes good use of time so as to not create needless overtime.

EDUCATION:

• Associate's Degree in Nursing

CREDENTIALS:

• REGISTERED NURSE

Southwell/Tift Regional Health System, Inc. is an Equal Opportunity Employer.