Provides leadership and management for the Department of Case
Management, Social Services and Clinical Resource Management.
Responsible for operational and human resource issues and issues
related to LOS and CMI, Discharge Planning, Case Management, and
Utilization Review. Oversees a systematic, holistic, outcome
oriented, customer-focused and cost-effective approach to the
integration and coordination of services for patients throughout
all levels of the organization.
PRINCIPAL DUTIES AND RESPONSIBILITIES(*Essential Functions)
Assume effective and efficient resource utilization for patient
in continum of care.
Assures timely and accurate utilization services for the
organization to include, appropriateness of admission, CMI and
Responsible for the development of systems and programs to
integrate appropriate levels of care.
Oversees the co-ordination of discharge planning and post
hospital planning which incorporates professional social work
Promotes the growth and development of all employees through
coaching, counseling, and self-education.
Provides effective orientation training and development of
Provides leadership, management and direction for the Case
Management, Social Services and Utilization Review staff to assure
timely intervention in the patient's treatment plans, appropriate
communications with health care team and utilization management and
ongoing assessment of the clinical progress for timely discharge
and transfers to other levels of care within the organization.
Provides oversight to Utilization team leaders related to
appeals, denials, correspondence with payors and regulatory
Reviews and analyzes patient outcome data to determine program
and service line changes as it relates to cost effectiveness,
quality integration of care and patient, payor and physician
JOB SPECIFICATIONS(Minimum Requirements)
KNOWLEDGE, SKILLS, AND ABILITIES
Demonstrated knowledge and skills to provide care appropriate to
the infant, child, adolescent, young adult, middle adult and
geriatric patient service on his/her service unit.
Demonstrated knowledge of the principles of growth and
development over the life span.
Demonstrates principles of excellent customer service and
responds positively to the needs of patients and family.
Excellent interpersonal skills using tact and diplomacy in
interventions with staff, patients and public.
Excellent communication skills both verbally and in writing.
Must be able to work cooperatively in a multi-disciplinary
Ability to assess and interpret data about the patient's status
in order to identify each patient's age specific needs and provide
the care needed by the infant, child, adolescent, young adult, and
geriatric patient groups serviced.
Ability to supervisor and give work directs to others.
Ability to professionally handle stressful situations
Bachelors Nursing Required
4 Healthcare/Medical - Case Management Preferred
4 Healthcare/Medical - Nurse: Staff Required
Licensed Registered Nurse
Certified Cardiac Pulmonary Resuscitation
STANDARDS OF BEHAVIOR
Meets the Standards of Behavior as outlined in Personnel Policy
and Procedure #1, Employee Relations Code.
Demonstrates knowledge of procedures for protecting and
maintaining security, confidentiality and integrity of employee,
patient, family, organizational and other medical information.
Understands and supports the commitment of Methodist Hospitals in
adhering to federal, state and local laws, rules and regulations
governing ethical business practices for healthcare providers.
DISCLAIMER - The above statements are intended to describe the
general nature and level of work being performed by people assigned
to this job. The statements are not intended to be construed as an
exhaustive list of all responsibilities, duties and skills