GENERAL SUMMARY OF DUTIES – The Director of Case Management’s primary responsibilities include: The manager of case management is responsible and accountable for the implementation of the case management program at the hospital level. The components/roles of the inpatient case management program consist of the following: care facilitation, utilization management, case management and discharge planning.

SUPERVISES – Case Managers and Social Workers

DUTIES INCLUDE BUT ARE NOT LIMITED TO

• Provide leadership, education and supervision for the day to day workflow of Case Managers and Social Workers.

• Monitor Case Management Department’s documentation to ensure meets regulatory compliance.

• Collaborate with Chief Financial Officer and Quality Department to develop and maintain quality improvement programs and trending of data (e.g. Avoidable Days , Readmissions) .

• Maintain skills in case management and utilization review to allow for coverage of patient caseload to cover staffing needs of all areas of hospital.

• Communicate with physicians concerning patient needs and aid with development of appropriate plan of treatment and assist with level of care and bed placement assignments .

• Directly responsible for personnel actions including hiring, performance appraisals ,employee schedules, and maintain payroll records and time reports in KRONOS.

• Facilitate daily Multidisciplinary Rounds to provide collaboration with other disciplines to provide holistic patient care.

• Participate in discharge planning. Provides necessary education and resources to meet the discharge needs of individual patients and families.

• Active participant of Utilization Review Committee and Revenue Recycle Committee.

• Promote efficient utilization of clinical resources.

• Promotes the appropriate amount of resources are used based on patient acuity.

• Assures appropriate level of understanding, awareness and compliance with all applicable Joint Commission, CMS, state and local agency laws, internal/external regulations, guidelines, policies, procedures and professional standards.

• Other duties as assigned.

KNOWLEDGE, SKILLS & ABILITIES

• Working knowledge of payer requirements and discharge planning regulations that support the effect for the development of departmental policies, procedures and standards .

• Working knowledge of Medicare, managed care, inpatient, outpatient and home health continuum, as well as utilization management , discharge planning and case management .

• Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.

• Working knowledge of concepts of associated with performance improvement.

• Self-motivated, proven communication skills, assertive, able to work independently and as a team member.

• Demonstrated effective working relationships with physicians.

EDUCATION

• Graduate of a program of Registered Nursing.

• Bachelor of Science in Nursing degree preferred.

EXPERIENCE

• Minimum of two years of Case Management experience in utilization management, case management, discharge planning or other cost/quality management program.

• Two to three years previous management experience is preferred with minimum of two years’ experience in hospital- based nursing.

CERTIFICATE/LICENSE

·       Iowa Mandatory Reporter – Child and Dependent Adult Abuse Certificates

·       Current RN license in the state of Iowa or a multistate license allowing to work in the state of Iowa