JOB SUMMARY

The Director of Case Management is responsible for the overall administration and direction of the Case Management Department, including planning, organizing, controlling, and directing all services and operations in the areas of care coordination, utilization, review and discharge planning. This position also serves as a leadership role in developing interfaces with clinical staff across the continuum and directly supervises the Case Management staff in the hospital. The Director of Case Management will ensure the competency, productivity and efficiency of the Case Management department while ensuring that the operations of the department are consistent with Texas Regional Medical Center at Sunnyvale (TRMC) organizational standards.

DUTIES AND RESPONSIBILITIES

Essential Job Duties

• Provides management direction to the Case Managers in the Case Management department.
• Identifies appropriate staffing levels, assignments and deployments for the department. Monitor performance criteria for staff members.
• Reviews operations of the Case Management department to ensure high level of quality is consistent with organization standards.
• Interprets laws, policies, operational procedures and objectives. Ensures compliance with regulatory and legal requirements.
• Responsible for collecting, analyzing, evaluating and presenting clinical management and operations data to a wide range of audiences.
• Develops care management programs, procedures, and clinical pathways that ensure efficient use of medical resources and provide optimum cost-effective, quality care.
• Works closely with the medical staff and senior leadership to identify patient care trends and issues.
• Work closely with medical staff leadership, clinical department chairs and committee chairs to ensure appropriate medical staff involvement in institutional resource management efforts.
• Participates on assigned medical staff, hospital committees; promotes effective communication between departments and entities, acting as a liaison to facilitate information sharing, collaborative problem solving and adequate provision of support services; fosters and maintains collaborative relationships within the hospital, and with external agencies related to quality and performance initiatives as well as day to day operations issues that may arise.
• Directly responsible for personnel actions including, but not limited to, hiring, performance appraisals, promotions, vacation schedules, and maintaining payroll records and time reports.
• Collaborate with administration, management and educational resources to develop mechanisms for staff development and to make appropriate changes as needed to keep department current with new regulations, policies and trends in the Case Management field.
• Participates in the preparation of department budget. Make budgetary recommendations and projections. Monitor, verify and reconcile expenditures of budgeted funds, compiling information reflecting expenditures, and develop cost-comparisons. Identify cost savings within the operation.
• Maintain skills in case management/utilization management to allow for coverage of a caseload as needed and/or to cover staffing shortages in the department
• Works to collaboratively achieve quality care outcomes fro patients as they transition from one setting to another.
• Actively participates in Utilization Management Committee, Performance Improvement, and other meetings as appropriate.
• Maintains a good working relationship both within the department and with other departments.
• Consults other departments as appropriate to collaborate on patient care and performance improvement activities.
• Documentation meets current standards and policies.

PROFESSIONAL REQUIREMENTS

• Adheres to dress code; appearance is neat and clean.
• Completes annual educational requirements.
• Maintains regulatory requirements, including all state, federal and The Joint Commission regulations related to the Imaging Services Department and, as appropriate, to the facility.
• Maintains and ensures patient confidentiality at all times.
• Reports to work on time and as scheduled.
• Wears identification while on duty.
• Attends annual review and performs departmental in-services.
• Complies with all organizational policies regarding ethical business practices.
• Represents the organization in a positive and professional manner.

REGULATORY REQUIREMENTS

• Bachelorâ��s degree in nursing or allied health field required or 5 years minimum experience as a Director of Case Management.
• Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.
• Experience in providing patient care.

LANGUAGE SKILLS

• Ability to read and communicate effectively in English.
• Additional languages preferred.

SKILLS

• Proficiency working with medical statistics and data, including databases.
• Ability to prepare statistical data and reports for formal presentations.

PHYSICAL DEMANDS

• For physical demands of position, including vision, hearing, repetitive motion and environment, see following description.

Employment 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.