Executive Director is responsible for Hospital wide Care Coordination including Case Management, Utilization Review and Denial Review, and Social Work Services. The Director is responsible for day-to-day operations including directing, organizing, developing and planning to ensure an effective discharge planning process. Executive Director will oversee an effective discharge planning process in collaboration with the Director of Medical Social Work and physician leaders responsible for inpatient management. Responsibilities also include oversight of the Regional Hospitals Case Management functions. Develops and implements the philosophies, policies, procedures, and goals for the case management department. The Executive Director should be knowledgeable of healthcare reimbursement, utilization management, discharge planning, and community resources. Works in an administrative, financial, and clinical capacity relative to planning, designing, implementation, and monitoring of systems necessary for the Hospital's Utilization Management Program as well as oversees the functions of the Utilization Management Committee. Oversees the Physician Advisor functions associated with Utilization Review functions. Assists with training and developing the case management staff and motivates them to accomplish department goals and objectives on-going. Understands, complies with, and communicates expected business ethics, state and federal regulatory requirements to department staff; assures that those supervised are compliant with expectations and all regulations. Assists in maximizing reimbursement by monitoring appropriate admissions, length of stay, denials, DRG changes, and/or quality of care citations. Directs the planning, designing, and implementation of the Utilization Review plan in accordance with the Center for Medicare Medicaid Services conditions of participation and for the Hospital's beneficiaries as well as other contracted employers. Provides consultation and education to facility leadership, clinical and financial personnel, and medical staff members related to case management, including utilization management and discharge planning practices. Demonstrates knowledge and skills to appropriately communicate and interact with the patients, families, and visitors of all age groups while being sensitive to their cultural and religious beliefs.
Qualifications:Education/Skills A registered Nurse Degree from a non-online accredited program is required. A Bachelor of Science Degree in Nursing or Master's Degree in Social Work is required.A Master's Degree in nursing is preferred.
Work Experience: Five or more years of experience in utilization/case management is required. Must have working knowledge and experience in Information Systems Management.
Certification/Licensure-DUE UPON HIRE- Licensed RN able to practice within the State of MS or
- Licensed Certified Social Worker (LCSW), as defined by Sec. 75-53-1 of Mississippi Code of 1972, required.