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Director of Case Management, Mount Vernon, WA

Skagit Regional Health


Mount Vernon, WA

June 12, 2017

Job Title Director/Case Management
Overtime Status: Exempt (FLSA Code)
Job Code: 11_134_87150
Reports To: Chief Medical Officer

Job Summary: The Director of Case Management provides oversight for directing and coordinating the departmental operations of Case Management, Utilization Review, Continual Document Improvement and Spiritual Care Services. This role serves as the central resource for the Executive Team concerning strategies regarding the optimization of provider documentation, status determination, and utilization of organizational resources. This positions is responsible for organizational resources through the patient continuum from point of entry through discharge and through work with post-acute care partners, assures the implementation of post-acute care plans. Facilitates and fosters the delivery of services through collaborative relationships by developing and leading teams of SRH and community partners. Must collaborate with all disciplines, departments, payers, system partners, vendors, and community agencies to reduce risk and optimize clinical outcomes within best practice, ethical, legal, and regulatory parameters. This position requires the ability to analyze complex tasks/systems/data and facilitate evidence-based change. This position will lead a team of RN’s, MSW’s and other staff.

Education: Bachelor of Science in Nursing required. Masters in nursing or healthcare related field preferred.

Experience: Five (5) years of management or supervisory background, Five (5) years of acute hospital direct care experience and Three (3) years acute hospital experience case manager,. Additional experience in non-hospital based health care (home care, insurance, outpatient, etc.) and managing staff or leading large-scale project implementations preferred.

Other Minimum Qualifications: Computer skills, critical thinking, DRG knowledge base, Medicare regulations, DNV guidelines understanding, medical necessity criteria, HIPAA, case management risk tools, collaborative networking skills. Human resource management, program evaluation and outcomes management, market assessment and strategic planning, LEAN principles knowledge, assessment of clinical skills, identification of at-risk populations, development of strategies to manage at-risk populations, use of MIDAS and other computer programs, collaborative, energetic, and proactive, respects nurses and physicians, and enjoys working with them, and technical writing for reports, letters, proposals, etc.

License/ Certifications: Washington State RN License required.

Essential Functions: Has a working knowledge of State/Federal/DNV guidelines regarding Case Management, Mental Health Unit, Chaplain and Palliative Care Services.

Develops a departmental case management performance improvement plan to assure appropriate and timely utilization of hospital, commercial and community based resources for optimal, cost effective service utilization. Collaborates with hospital based personnel and community facilities to coordinate effective and efficient patient throughput from the emergency department, medical and mental health units through to outside partners. Works with the Population Health department on the continuum of care.

Supervises RN utilization team, continual documentation improvement team Supervises Mental Health Unit departmental manager, Chaplain, and MSW Clinical Supervisor. Partners with the Hospitalist Medical Director(s) for effective relationships with physicians, services and specialties to optimize utilization practices. Provides consultation regarding organizational utilization to the executive team, forming effective relationships with all SET and department heads. Collaborates with direct reports to establish, implement, and evaluate a written strategic plan for each oversight area that takes into account internal and external factors. Establishes, manages, and constantly evaluates staffing levels, assignments, skills, learning needs, and deployment of staff. Creates stable and reliable processes to anticipate and address specific situations within each department and between the department, organizational departments and outside agencies. Establishes effective communication systems and forums with third party payers, the local PRO/QIO, Medical Records/coding, business office, finance and community agencies as applicable for each internal department under the direction of the Case Management Director.

Develops structures and processes to facilitate participation by physicians and other health professionals in multidisciplinary care planning, care delivery, and discharge planning for medical and mental health departments under the Case Management Director. Develops and manages the operational budget for areas of oversight.

Oversees all working contracts and policies related to programs of oversight. Develops individually, or in partnership with those in leadership roles under CM Director, annual and probationary performance evaluations for all staff in assigned departments under Case Management Director.

Offers expertise on organizational committees as requested. Collaborates with all disciplines and departments to optimize key clinical and financial outcomes within best practice, legal and regulatory parameters. Presents executive team with ongoing, reliable information about the treatment and flow of patients at all levels. Establishes, manages and evaluates departmental policies and contracts. Sorts through multiple inputs and feedback to generate a clear direction for all departments of oversight. Clarifies departmental directions and successfully manages change.

Formulates effective approaches to developing and managing change.

Partners in developing and overseeing capital and operating budget for designated departments.

Other duties as assigned.

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