·         Responsible for 24 hour departmental coverage regarding Case Management and Social Services.

·         Serves as a resource person & internal consultant to department heads, medical staff & hospital staff, relating to Case Management.

·         Initiates problem investigations in response to concerns received for investigation & action by appropriate manager.

·         Responsible for ongoing education to hospital staff on Case Management.

·         Responsible for positive staff morale, staff absenteeism management and low turnover.  Ensures qualified new hires and vacancies levels are appropriate.

·         Reviews all Quality Assurance referrals from Case Managers and refers cases for peer review.

·         Accountable for the selection, performance & retention of qualified staff  to carry out quality care systems in accordance with defined needs & organization objectives.

·         Responsible for the budget development & implementation of  the  Case Management department.

·         Responsible for close interaction with Administration & physicians to manage costs & quality of care.

·         Coordinates the design, development & evolution of systems to monitor & evaluate the achievement of optimal clinical outcomes.

·         Contributes to Nursing Services & institutional operations through active participation on committees & programs.

·         Guides practice groups in the team development of critical paths to yield patient specific & aggregate data related to patient outcome,

·         Coordinates creative interventions directed at reducing acute Medicare and MediCal length of stay to established targets.

·         Facilitates reduction in MediCare Delay of Service and End of Stay denials.

·         Facilitates reduction in out-of-network days by capitated patients.

·         Assures Medicare Milliman Clinical Guideline (MCG) are used to document and communicate Intensity of Service and Severity of Illness.

·         Coordinates and communicates Avoidable Patient Day trending/ profiling.

·         Participates in hospital/medical group Joint Operating Committee meetings.

·         All other duties as assigned.