The Director of Case Management Full Time Days Position Summary
The Director of Case Management plans, organizes, implements, and directs care coordination activities at Piedmont Medical Center. He/she is responsible for providing oversight and broad direction to case management, which includes care coordination, utilization review, social services, and discharge planning. The Director of Case Management works closely with the medical staff and Piedmont Medical Center leadership to identify patient care trends and issues. The Director develops care management programs, procedures, and clinical pathways that ensure efficient use of medical resources and provide optimum cost effective, quality care.
Qualifications - External
THE DIRECTOR OF CASE MANAGEMENT FULL TIME DAYS CANDIDATE POSSESS THE FOLLOWING EDUCATION, LICENSE/CERTIFICATIONS, AND EXPERIENCE.
This position requires proficiency in working with medical statistics and data, including databases. Experience with medical statistical process and control procedures is required. The Director of Case Management must possess excellent written and verbal communication skills and demonstrate the ability to prepare statistical data and report for formal presentations. The Director of Case Management must effectively interact with individuals who possess diverse personalities and levels of professional expertise.
Minimum Education: BSN or LMSW required, MSN preferred, willing to pursue Masters.
Minimum Experience: Five to seven years of experience with utilization review, clinical pathways, case management, and disease management are required. Supervisory experience is preferred.
Education:
Required: Bachelor's degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW
Preferred: MSN, MBA, MSW, or MHA
Experience:
Required: 3 years of acute hospital case management or healthcare leadership experience
Preferred: 5 years of acute hospital case management leadership multi-site experience
Certifications:
Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW/LMSW license for state(s) covered.
Preferred: Accredited Case Manager (ACM)
Physical Demands:
Lift/position up to 25 lbs. Push/pull up to 25 lbs. of force. Frequent sitting. Moderate standing, walking, reaching, stooping, and bending. Manual dexterity, mobility, touch, auditory to perform all the related duties of the position.
The individual’s responsibilities include the following activities:
a) manage department operations to assure effective throughput and reimbursement for services provided,
b) lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement,
c) ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policy,
d) ensure timely and effective patient transition and planning to support efficient patient throughput,
e) implement and monitor processes to prevent payer disputes,
f) develop and provide physician education and feedback on hospital utilization,
g) participate in management of post-acute provider network,
h) ensure compliance with state and federal regulations and TJC accreditation standards and
i) other duties as assigned.
Who We Are
We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community.
Our Story
We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care.
We have a rich history at Tenet. There are so many stories of compassionate care; so many "firsts" in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need. Tenet and our predecessors have enabled us to touch many different elements of healthcare and make a difference in the lives of others.
Our Impact Today
Today, we are leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions.
Our impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. We are differentiated by our top notch medical specialists and service lines that are tailored within each community we serve. The work Conifer is doing will help provide the foundation for better health for clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions.
Together as an enterprise, we work to save lives and can accept nothing less than excellence from ourselves in service of our patients and their families, every day.
Read Full Description