Under the direction of the Director, Case Management, this position is responsible for overseeing and managing the day-to-day operations of the inpatient and outpatient case management department. This position works closely with the Director, Medical Director and Senior Management to evaluate and monitor medical appropriateness determinations and care coordination activities. This position is responsible for developing and implementing strategic plans which will have a direct impact on cost containment and improved patient outcomes.
Ensures compliance with regulatory requirements and application of clinical decision support criteria for care management activities deemed by Federal, State and other regulatory and accreditation agencies for inpatient and outpatient case management
Oversee activities of population health management program and works to integrate inpatient and outpatient programs
Assesses the non-clinical and clinical staff training needs and completes necessary desktop procedures, workflows, and/or resource guides to assist staff core job functions.
Responsible for monitoring inpatient rounds and outpatient care team meetings to ensure quality of the exchange of patient information
Responsible for ensuring staff receive performance data and assist staff with developing plans to meet daily goals.
Conducts meetings with staff to implement approved Policies and Procedures or workflows as needed.
Responsible for performing following team members when necessary, the essential functions of the RN Outpatient CM, LVN Outpatient CM, LVN Inpatient CM, and RN Inpatient CM.
Serves as a resource for assigned case management team.
In the absence of the manager, will support the managerial role.
Performs all other related duties assigned.
Measurement of Success, for on-going and annual performance evaluation:
EXCEEDS PERFORMANCE REQUIREMENTS
Met target on 90% of the Department’s Performance Metrics.
Established training plan for areas of accountability with deployment timeline
2. Effective time management demonstrated by meeting all regulatory and
health plan requirements.
No more than one corrective action per functional unit per health plan audit.
Free of repeat deficiencies identified in area (s) of accountability.
3. Established employee engagement and development processes
90% of start, stop issues are addressed for the areas of accountability