Incumbent is responsible for:
• Planning, organizing, managing and evaluating Utilization Management and Case Management teams.
• Monitors achievement of program objectives and implement program changes to improve outcomes.
• In collaboration with the Manager, the Supervisor prepares, administers and monitors departmental operating and capital budget and maintains budgets within allocated funds.
• Participates in the development of policies and procedures of the Department. Allocates and assigns staff for proper utilization of personnel in relation to patient, service line and organizational needs.
• Initiates hiring and termination decisions, and performs timely annual evaluations and coaching sessions.
• Schedules and monitors assignments, and controls staffing levels to meet budgetary guidelines.
• Provides counseling, training, and addresses disciplinary problems.
• Maintains a supportive attitude towards department and facility goals, plans, policies, and procedures.
• Promotes the role of utilization management and case management within the Health System by effective liaison with managers, directors and physician leaders.
• Participates in the planning and development of educational programs for Utilization Management and Case Management staff. Coordinates and documents departmental orientation and in-service training.
• Provides expertise and direction to Hospital Care Management staff for solving complex clinical and financial patient situations regarding reimbursement issues, discharge planning, utilization review, continuity of care, and systems management.
• Supports culture of continuous quality improvement. Works within a team environment to manage the total function of the Hospital Care Management service. Actively participates in organizational committees.
• Participates in activities of professional associations.
• Promotes a positive, safe environment.
• Keeps abreast of current professional standards in the health field and makes recommendations on changes in policy and programs.
• In collaboration with the treatment team, attending physician, and external entities, may provide direct service care to patients.
• Performs other related duties as may be requested by Administration of the Health System.
KNOWLEDGE, SKILLS AND ABILITIES:
• Thorough working knowledge of Medical Terminology.
• Demonstrated knowledge of:
• Utilization Management and Case Management principles and methodology
• Knowledge of Levels of Care (Acute care, Critical Care, Acute Rehab, LTAC, SNU, Subacute, Outpatient, Home Health, Day Tx.)
• Thorough working knowledge of:
• Government, county, private, and workers compensation funding sources.
• Eligibility criteria
• Criteria for determining level of care, and familiarity with managed care (HMO, PPO, PSO, and capitation)
• Federal and State regulatory requirements and URAC standards
• Demonstrated ability to:
• Communicate effectively with health care professionals and external case managers.
• Identify obstacles to patient progress and barriers to discharge.
• Problem solve with medical team to remove such barriers.
• Maintain professional relationships; work effectively and collaboratively with other members of the medical team.
• Actively pursue continuing education and training opportunities in Utilization Management or Case Management.
• Ability to maintain knowledge regarding standards of care, case management/utilization principles and approaches, Social Services, discharge management and Spiritual Care.
• Ability to maintain confidentiality regarding the medical record.
• Understand insurance and payer requirements.
• Demonstrate the knowledge and skills necessary to provide care based on physical, motor/sensory, psychosocial, and safety appropriate to the age.
• By nature of current license for RN and department evaluation competency is demonstrated for ability to perform job duties.
This position may provide direct patient care.
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