Responsible for the overall administration and direction of the Case Management/Social Services Department, including planning, organizing, controlling, and directing all services and operations in the areas of Utilization Review and Discharge Planning. With primary focus of this role being on throughput, additional responsibilities will be oversight of the nursing office (House Supervisors and Staffers).
This position requires providing managerial/administrative supervision to departments which provide services to critically ill through rehabilitating neonatal through geriatric patient population in a manner that demonstrates an understanding of the functional and/or developmental age of the individual served.
· 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
· 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
· 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 InterQual criteria 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.
Current CA RN License.
Current AHA BCLS Certification.
Case Management Certification.