Full-Time
Director of Case Management
Direct Staffing
No salary listed
Melrose Park, IL, USA
In Person
Category
 Medical, Clinical & Veterinary (2) |
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Requirements
- Current licensure as a registered nurse in the state of Illinois
- Three years of relevant clinical experience required, with a minimum of two years of relevant management experience
- Three years of Utilization Management/Case Management experience, preferably in an acute hospital setting
- Extensive knowledge in reimbursement methodology and Case Management activities
- Critical thinking skills, effective written and verbal communications skills, strong self-initiative and interpersonal skills
- Strong leadership skills
Responsibilities
- Oversees the pre-screening of scheduled cases and admissions for appropriate criteria/pre-certs/approvals
- Assures proper patient care coordination including Admission Assessment, planning, implementation and evaluation with communication to other departments and outside agencies
- Provides continuing analysis on LOS, average charge, readmissions and patient outcomes for a Case Management report
- Utilizes an interdisciplinary process to assess, plan and provide patient care for specific diagnoses from pre-admission through aftercare
- Advises physicians of special documentation requirements when needed and assists them in identifying alternatives to cases that do not require acute care
- Negotiates with physician/payers in advance and assists in arranging transfers or alternate placement when indicated
- Facilitates and collaborates with Case Managers and other allied health professionals to promote and ensure that quality care is provided and outcomes are achieved in a timely and cost-effective manner
- Serves as a clinical instructor for case managers in education, training and mentorship
- Develops and maintains a departmental budget for the Case Manager staff and a quality assurance plan
- Coordinates activities to develop and implement departmental and corporate goals
- Develops and reviews the annual updating of the Departmental Plan, monitors trends and variances from expected outcomes and implements strategies to resolve them
- Develops, administers and reviews policies and procedures as required
- Participates in the measurement of patient/family/decision maker expectations, involvement in care decisions and satisfaction
- Actively engaged with other areas of the hospital in the appropriate post-hospital utilization of resources, adequate education of patient and hospital staff and decreased incidence of re-admissions
- Coordinates the activities of the Utilization Review Committee and works closely with the Physician Advisor in this role
- Assists in gathering data related to indicators for the department on a regular basis analyzes the data and creates action plans for performance improvement
- Reviews patient satisfaction data. Participates in the appropriate follow-up of any companies and handles department performance improvement
- Hires, promotes, demotes, separates and writes/administers performance evaluations to subordinate staff as necessary within their assigned area
- Conforms to the established Standards of Behavior
- Other duties as assigned
Desired Qualifications
- Current certification in an approved Case Management Program preferred
- Hospital Case Management Experience-Plus