A Brief Overview Manages and coordinates hospital-wide case management, utilization review and social work services to ensure continuity of patient care activities from point of entry through discharge. Works collaboratively with medical/hospital staff for coordination and management of patient care and social services to effectively integrate activities. Assures compliance with organizational and regulatory standards and requirements.
What you will do - Apprises Director, Case Management of all activities, pertinent changes in internal/external market, threats, and opportunities in a timely and anticipatory manner and presents action plans for immediate implementation/approval.
- Maintains current awareness of customer needs and meets standards and requirements to manage the day-to-day operations of case management, utilization review, outside purchased medical services and social work services. •Assists Director in developing objectives, policies, procedures and standard of performance. •Consults with other departments and medical hospital personnel in planning case management/utilization review/social services and educational programs. Develops and maintains working relationships with other departments. •Represents the Department on various committees, i.e., hospital management, patient care, utilization review. •Resolves complaints, conflicts and operational problems. Identifies problems, documents resolutions and communicates with applicable parties to ensure that operational issues are handled and resolved in a timely manner. Informs Director of any problems which cannot be resolved or require intervention. •Ensures that staff works in collaboration with other disciplines, physician, health care team members, and external healthcare organizations for inpatient, outpatient and post hospitalization needs according to patient plan of care. •Assists in the development of statistical data each month. •Makes changes and recommendations as needed to enhance/improve services and efficiency in operations. •Assists in the development and management of departmental budget accordance to established goals.
- Coordinates and implements case management activities to facilitate the patient care plan from admission to post discharge placement. •Responsible for coordinating, implementing, and monitoring case management assessments or evaluations of patient from point of entry through discharge. •Ensures the review of patients' medical charts to ascertain the medical necessity for services and the appropriateness of level of care to maximize the efficient delivery of care, ensuring the appropriate use of hospital resources and for monitoring the length of stay to minimize avoidable days. •Ensures use of appropriate codes, correctness of primary reason for admission and certified hospital days, and inclusion of all relevant supporting medical information. •Ensures continuous communication with third party payors on certification/continued stay issues.
- Coordinates and implements social work services to ensure the timely delivery of supportive professional psychosocial services to patients, families, and hospital staff. •Ensures that assessment, intervention and planning address the age appropriate psychosocial needs of patient and families/significant others. •Ensures that assessments are documented within twenty-four (24) business hours of referral. •Monitors and tracks social services delivery patterns and develops programs to capture target patient population.
- Coordinates and implements utilization review programs, activities and systems measurements for concurrent and retrospective chart review of patients to ensure that the hospital meets established objectives.
- Implements policies and procedures to ensure that patients are discharged from the hospital with appropriate support systems to prevent re-admission.
- Investigates identified variations from quality standards, pursues opportunities to resolve problems and follows-up on resolutions for compliance and effectiveness of corrective actions.
- Maintains current knowledge of management information systems to utilize the computer system and produces data on healthcare utilization, case management and social work services.
- Demonstrates the knowledge and skills necessary to provide care appropriate to patient population and within clinical competency. Demonstrates knowledge of the principles of growth and development and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify the requirements of each patient, and to provide the care needed as described in departmental policies and procedures.
- Works collaboratively with hospital staff and other community/human services agencies to coordinate intervention activities; ensures that patients receive efficient services for problem resolution.
- Prepares and maintains required reports, records and files for administrative and operational purposes. •Utilizes computer and information systems to enter, format data and generates statistics, computations, tables, charts and graphs. •Utilizes analytic skills and statistical analysis to aggregate data to assist with the identification of potential problems and patterns, trends, establishes priorities and recommends improvement activities.
- Plans work schedules, assigns work and monitors workflow to provide adequate support/services at all times through individual or cooperative activities. •Effectively makes work assignments, delegates responsibilities, sets priorities and redirects employees to other tasks as the need arises. •Audits work of staff to ensure quality in all job duties. •Ensures staff meets job demands and productivity levels.
- Manages activities of employees. Develops and motivates direct reports to ensure that a capable, productive staff exists in the department. •Assists in selecting staff. Orients, trains and develops staff to meet requirements set forth in department plan. •Provides in-services and training opportunities for staff. •Evaluates performance and initiates corrective action as required.
- Completes required continuous training and education, including department specific requirements to maintain knowledge of case management and utilization review practices. Responds to problems/opportunities to improve work environment and participates in unit based performance improvement activities. •Attends in-services, educational programs, conferences and other meetings as required. •Supports and is involved in the organization's Performance Improvement initiatives.
- Coordinates and integrates activities within case management and other departments to maximize overall effectiveness of the department.
- To model The Regional Medical Center at Memphis' mission and values at all times.
Qualifications - Bachelor's Degree In Nursing, Social Work or health related field Required
- Licensure to work in state of TN Upon Hire Required
- Minimum 3 years experience Three (3) years progressive experience in nursing, social work services or utilization management. Required and
- Minimum 1 year experience One (1) year supervisory experience Preferred
Physical Demands - Standing - Occasionally
- Walking - Occasionally
- Sitting - Constantly
- Lifting - Rarely
- Carrying - Rarely
- Pushing - Rarely
- Pulling - Rarely
- Climbing - Rarely
- Balancing - Rarely
- Stooping - Rarely
- Kneeling - Rarely
- Crouching - Rarely
- Crawling - Rarely
- Reaching - Rarely
- Handling - Occasionally
- Grasping - Occasionally
- Feeling - Rarely
- Talking - Constantly
- Hearing - Constantly
- Repetitive Motions - Frequently
- Eye/Hand/Foot Coordination - Frequently
Regional One Health is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.