Director Case Management FT Days
Company: DMC Receiving Hospital
Location: Detroit
Posted on: April 25, 2024
|
|
Job Description:
POSITION SPECIFIC RESPONSIBILITIES:
Department Operations
- Maintains an adequate number and skill mix over seven days a week
to serve the patient population and meet the goals of the
department
- Implements and supports with business case staffing requests
utilizing the Tenet Case Management staffing recommendations and
hospital budgetary guidelines
- Holds regular departmental meetings with staff to provide updates
and provides for ongoing education
- Completes initial and annual competency and evaluation review on
all case management staff
- Follows the InterQual Inter-rater Reliability (IRR) Policy to
determine initial and yearly competency for all employees
performing InterQual reviews
- Develops action plan for case managers that fail to meet the IRR
acceptable "match" rate to ensure improvement in the accurate
application of InterQual criteria
Utilization Management
- Implements and monitors processes to ensure medical necessity
review processes are in place for patients to be in the appropriate
status and level of care per Tenet policy.
- Oversees submission of cases to Physician Advisor review to
ensure timely referral, follow up and documentation.
- Implements and monitors utilization review process in place to
communicate appropriate clinical data to payers to support
admission, level of care, length of stay and authorization for
post-acute services.
- Advocates for the patient and hospital with payers to secure
appropriate payment for services rendered
- Implements and monitors physician "peer to peer" review process
with payers to resolve denials or downgrades concurrently.
Transition Management
- Implements and monitors process to ensure that a transition plan
assessment is completed within 24 hours of patient admission to
identify and document the anticipated transition plan for
patients
- Ensures case management staff use electronic referral request
process for patient placements
- Monitors to ensure that patient choice is documented per CMS
regulations and Tenet policy
Care Coordination
- Works with Nursing and hospital leadership to ensure Patient Care
Conferences and Complex Case Review processes are in place to
promote timely and appropriate throughput
- Participates in daily bed management meeting to support timely
and effective patient placement and transfer within the
hospital
- Monitors to ensures that patients have a plan of care that is
clinically appropriate, consistent with patient choice and
available resources
- Monitors to ensures consults, testing and procedures are
sequenced to support clinical needs with timely and efficient care
delivery
- Ensures patient needs are communicated and that the healthcare
team is mutually accountable to achieve the patient plan of
care
- Effectively collaborates with physicians, nurses, ancillary
staff, payors, patients and families to achieve optimum clinical
outcomes
Education
- Provides education to physicians regarding medical necessity,
complete and accurate documentation, and compliance with related
regulatory requirements
- Prepares and provides data to physicians and the hospital on
utilization of resources
- Provides education to case management staff, physicians and the
healthcare team.
Compliance
- Ensures compliance with federal, state, and local regulations and
accreditation requirements impacting case management scope of
services
- Ensures that the department structure and staffing, policies and
procedures to comply with the CMS Conditions of Participation and
Tenet policies
- Operates within the RN scope of practice as defined by state
licensing regulations
Minimum Qualifications
1. Graduate from an accredited school of Nursing. Bachelor's degree
in Nursing or other health-related field, or the equivalent
combination of education and/or related experience. Master's degree
in Nursing, Business Administration or Hospital Administration
preferred.
2. Licensed to practice as a Registered Nurse in the State of
Michigan;
3. Three to five years of acute hospital case management leadership
experience. Five years acute hospital case management experience
preferred. McKesson InterQual - experience preferred. Business
planning experience preferred.
4. Accredited Case Manager (ACM) preferred.
Skills Required
1. Analytical ability to serve in an advisory/consultative role in
determining and/or developing strategies, policies, processes,
protocols and methods, frequently in the absence of guidelines or
technical assistance, and to evaluate and direct complex systems
that foster innovative approaches to procedures/processes.
2. Fiscal skills to monitor and control costs and revenue.
3. Ability to cope with stressful situations, manage multiple and
sometimes conflicting priorities simultaneously.
4. Strong communication and interpersonal skills for frequent
contacts with internal customers as well as stakeholders external
to the DMC to persuade or negotiate on a wide range of subjects in
situations which may be controversial, sensitive and/or lead to
confrontation. A mastery of a variety of communication modalities
is required to include leading meetings, making formal
presentations, and writing complex documents and managing complex
relationships over time.
5. Teaching abilities to conduct educational programs for
staff.
6. Project management skills including the ability to define
program, project, or process objectives, identify stakeholders and
their interests, plan steps, coordinate and allocate human,
technological and fiscal resources to accomplish goals and
objectives in a resourceful yet timely manner.
7. Leadership skills including demonstrated willingness to pursue
leadership roles with increasing levels of accountability, comfort
with decision-making responsibilities, coaching, teaching and
counseling skills, and the ability to inspire and build confidence
in others and to forge alliances and garner support.
8. Technical knowledge of community resources, regulatory
requirements, reimbursements and utilization management procedures
in order to function as a resource for staff.
Qualifications:
POSITION SPECIFIC RESPONSIBILITIES:
Department Operations
- Maintains an adequate number and skill mix over seven days a week
to serve the patient population and meet the goals of the
department
- Implements and supports with business case staffing requests
utilizing the Tenet Case Management staffing recommendations and
hospital budgetary guidelines
- Holds regular departmental meetings with staff to provide updates
and provides for ongoing education
- Completes initial and annual competency and evaluation review on
all case management staff
- Follows the InterQual Inter-rater Reliability (IRR) Policy to
determine initial and yearly competency for all employees
performing InterQual reviews
- Develops action plan for case managers that fail to meet the IRR
acceptable "match" rate to ensure improvement in the accurate
application of InterQual criteria
Utilization Management
- Implements and monitors processes to ensure medical necessity
review processes are in place for patients to be in the appropriate
status and level of care per Tenet policy.
- Oversees submission of cases to Physician Advisor review to
ensure timely referral, follow up and documentation.
- Implements and monitors utilization review process in place to
communicate appropriate clinical data to payers to support
admission, level of care, length of stay and authorization for
post-acute services.
- Advocates for the patient and hospital with payers to secure
appropriate payment for services rendered
- Implements and monitors physician "peer to peer" review process
with payers to resolve denials or downgrades concurrently.
Transition Management
- Implements and monitors process to ensure that a transition plan
assessment is completed within 24 hours of patient admission to
identify and document the anticipated transition plan for
patients
- Ensures case management staff use electronic referral request
process for patient placements
- Monitors to ensure that patient choice is documented per CMS
regulations and Tenet policy
Care Coordination
- Works with Nursing and hospital leadership to ensure Patient Care
Conferences and Complex Case Review processes are in place to
promote timely and appropriate throughput
- Participates in daily bed management meeting to support timely
and effective patient placement and transfer within the
hospital
- Monitors to ensures that patients have a plan of care that is
clinically appropriate, consistent with patient choice and
available resources
- Monitors to ensures consults, testing and procedures are
sequenced to support clinical needs with timely and efficient care
delivery
- Ensures patient needs are communicated and that the healthcare
team is mutually accountable to achieve the patient plan of
care
- Effectively collaborates with physicians, nurses, ancillary
staff, payors, patients and families to achieve optimum clinical
outcomes
Education
- Provides education to physicians regarding medical necessity,
complete and accurate documentation, and compliance with related
regulatory requirements
- Prepares and provides data to physicians and the hospital on
utilization of resources
- Provides education to case management staff, physicians and the
healthcare team.
Compliance
- Ensures compliance with federal, state, and local regulations and
accreditation requirements impacting case management scope of
services
- Ensures that the department structure and staffing, policies and
procedures to comply with the CMS Conditions of Participation and
Tenet policies
- Operates within the RN scope of practice as defined by state
licensing regulations
Minimum Qualifications
1. Graduate from an accredited school of Nursing. Bachelor's degree
in Nursing or other health-related field, or the equivalent
combination of education and/or related experience. Master's degree
in Nursing, Business Administration or Hospital Administration
preferred.
2. Licensed to practice as a Registered Nurse in the State of
Michigan;
3. Three to five years of acute hospital case management leadership
experience. Five years acute hospital case management experience
preferred. McKesson InterQual - experience preferred. Business
planning experience preferred.
4. Accredited Case Manager (ACM) preferred.
Skills Required
1. Analytical ability to serve in an advisory/consultative role in
determining and/or developing strategies, policies, processes,
protocols and methods, frequently in the absence of guidelines or
technical assistance, and to evaluate and direct complex systems
that foster innovative approaches to procedures/processes.
2. Fiscal skills to monitor and control costs and revenue.
3. Ability to cope with stressful situations, manage multiple and
sometimes conflicting priorities simultaneously.
4. Strong communication and interpersonal skills for frequent
contacts with internal customers as well as stakeholders external
to the DMC to persuade or negotiate on a wide range of subjects in
situations which may be controversial, sensitive and/or lead to
confrontation. A mastery of a variety of communication modalities
is required to include leading meetings, making formal
presentations, and writing complex documents and managing complex
relationships over time.
5. Teaching abilities to conduct educational programs for
staff.
6. Project management skills including the ability to define
program, project, or process objectives, identify stakeholders and
their interests, plan steps, coordinate and allocate human,
technological and fiscal resources to accomplish goals and
objectives in a resourceful yet timely manner.
7. Leadership skills including demonstrated willingness to pursue
leadership roles with increasing levels of accountability, comfort
with decision-making responsibilities, coaching, teaching and
counseling skills, and the ability to inspire and build confidence
in others and to forge alliances and garner support.
8. Technical knowledge of community resources, regulatory
requirements, reimbursements and utilization management procedures
in order to function as a resource for staff.
Job:
Managers and Directors
Primary Location:
Detroit, Michigan
Facility:
DMC Receiving Hospital
Job Type:
Full Time
Shift Type:
Days
2406000688Employment practices will not be influenced or affected
by an applicant's or employee's race, color, religion, sex
(including pregnancy), national origin, age, disability, genetic
information, sexual orientation, gender identity or expression,
veteran status or any other legally protected status. Tenet will
make reasonable accommodations for qualified individuals with
disabilities unless doing so would result in an undue hardship.
Keywords: DMC Receiving Hospital, Dearborn , Director Case Management FT Days, Executive , Detroit, Michigan
Click
here to apply!
|