Maria Parham Health
Who We Are:
People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. With 205 licensed beds, Maria Parham Health is equipped for every health care need one can encounter. We are fully licensed by Joint Commission, the College of American Pathologists, and Rated Highest In-Patient Safety from Leapfrog.
Where We Are:
Henderson offers a great outdoors, including the region’s largest lake, providing endless hours of fun boating, fishing, water skiing, and camping. Throw in great golfing, hunting and two fantastic recreational organizations and you may find yourself having a hard time deciding what to do next!
Why Choose Us:
· Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
· Competitive Paid Time Off, PTO cash out, and PTO donation programs
· Employee Assistance Program – mental, physical, and financial wellness assistance
· Loan Repayment and Tuition Reimbursement/Assistance for qualified applicants
· Robust employee recognition and awards programs
· And much more…
Position Summary
The Case Management Director is the first line manager designated as the leader for Case Management team. the Case Management Director has accountability and responsibility for departmental functions of case management, concurrent coding, utilization review, financial outcomes management, social work, patient education. Plans, coordinates, directs the fiscal, personnel and patient care needs and the age of the patient in as cost-effective manner as possible. Collaborates with Quality Management and Nursing Directors in promoting positive clinical outcomes. Responsible for integration of the department into the overall functioning of the organization. Performs other related duties as assigned.
Reports to: Chief Financial Officer
Responsibilities of the Position
Develops and implements departmental goals, plans, and standards consistent with the clinical, administrative, legal, and ethical requirements/objectives of the organization.
Directs and evaluates departmental operations, including patient care delivery, information technologies, service level determination, and complaint management, to achieve performance and quality control objectives.
Plans and monitors staffing activities, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
Prepares, monitors, and evaluates departmental budgets, and ensures that the department operates in compliance with allocated funding. Coordinates and directs internal/external audits.
Creates and fosters an environment that encourages professional growth.
Integrates evidence-based practices into operations and clinical protocols.
Provides clinical leadership for the Patient Care Coordinators and Social Worker for day-to-day issues regarding quality, resource management, utilization review, and discharge planning.
Reviews the delivery of services and care provided in the acute care setting for medical necessity, appropriateness, and conformance to professional standards developed by the Hospital, managed care, and regulatory organizations.
Collaborates with Nursing Director regarding interdisciplinary patient care rounds.
Participates in hospital and departmental safety programs.
Participates in Performance Improvement. Collects data and identifies opportunities for improvement.
Communicates responses to potential or actual payment denials.
Collaborates with individual physicians to resolve utilization review concern.
Performs re-review of discharged cases as requested by Medical Records, Business Office, or 3rd Party Payor.
Serves as resource for Medical Advanced Beneficiary Notice issues.
Issues Hospital Notice of Non-Coverage as required by hospital policy.
Develop quarterly reports for variance tending and action plans.
Educates the Medical Staff regarding the Case Management program and the need for timely and meaningful documentation.
Participates in Medical records coding evaluations and collaborates with Medical Records Director on strategies for compliance in documentation and coding.
Provides feedback of clinical and administrative data to physicians in a confidential, professional manner so they can objectively assess patterns of care over time. Utilizes physician practice data in appropriate manners to effect clinical and financial outcomes
Review case mix, LOS, DRG coding on a regular basis. Apply information to improvement opportunities and organizational priority setting.
Other tasks and duties as assigned.