Manager of Case Management - LTAC

Kentfield, CA 94904

Posted: 11/23/2021 Category: Nursing Job Number: 91962

Job Description


POSITION SUMMARY
Responsible for monitoring quality patient standards, patient, and payor satisfaction levels, and for ensuring that patients are receiving prioritized, cost-appropriate and quality services. Will assess, organize, develop, implement, and evaluate the case management program and activities in accordance with current federal, state, and local standards, guidelines and regulations and the Joint Commission standards. Demonstrates knowledge and skills necessary to provide case management services to the patient population experiencing medically complex conditions, general medical-surgical conditions with rehabilitation and wound care needs.
 

POSITION QUALIFICATIONS

Minimum Qualifications:
  • Current, valid, and active license to practice as a Registered Nurse in the state of employment required.
  • Minimum two (2) years of hospital case management experience required.
  • Current BLS certification required.

Additional Qualifications/Skills:
  • Previous LTAC experience preferred.
  • ACM or CCM and CCDS certification preferred.
  • Previous management experience preferred.
  • Strong leader and manager, able to motivate staff to deliver high quality, results-oriented case
  • management services.
  • Strong written and oral communication skills.
  • Assertive and personable with the ability to balance the complex challenge of delivering quality, cost appropriate,
  • and service-oriented outcomes.
  • Demonstrates comprehensive knowledge of the principles and concepts of case management and
  • applicable standards of voluntary and regulatory agencies for review activities.
  • Proficient in collecting and retrieving material from medical records.
  • Knowledgeable in utilization review, medical terminology, appropriate levels of care, treatment, modalities,
  • statues, and healthcare delivery models.
  • Interpersonal relationship abilities must be highly refined with negotiation and problem solving skills at a
  • very high level.
  • Must possess strong clinical assessment and process skills.
  • Ability to project a professional image.
  • Knowledge of regulatory standards and compliance requirements.
  • Strong organizational, prioritizing, and analytical skills.
  • Ability to make independent decisions when circumstances warrant.
  • Working knowledge of computer and software applications used in job functions.

CERTIFICATES, LICENSES, REGISTRATIONS
  • Current, valid, and active license to practice as a Registered Nurse in the state of employment required.
  • Current BLS certification required. CCM/CCDS certification preferred.

JOB FUNCTION
  • Assess, develop, organize, implement, evaluate, coordinate and direct the case management program in the hospital. Works closely with hospital and medical staff to ensure delivery of quality, cost-appropriate, and service-oriented outcomes to patients. Monitors case management services to evaluate appropriateness and improvement of care. Provides direct case management interventions as required. Organizes and oversees interdisciplinary team meetings. Reviews pre-admission screening for utilization review, funding and discharge planning issues. Leads and advocates for clinical documentation improvement initiatives, and appropriate DRG assignment in the hospital. Ensures that case management systems, utilization review practices and discharge planning processes are timely and appropriate.
  • Provides education, support and training to patients, families, employees, and medical staff on case management function. Reviews department level policies and procedures and communicates with staff as required. Provides appropriate explanations and assistance to patients and families during the entire patient stay and case management process.
  • Works closely with Admissions and/or other financial staff to formulate plan of care for precertification of potential admission. Provides ongoing communication as required regarding funding issues and assure continued fiscal appropriateness of patient admissions and continued stay reimbursement.
  • Remain current with literature related to departments for which responsible and maintain an updated methodology, tools, manuals, and criteria as necessary and appropriate.      

 

ADDITIONAL RESPONSIBILITIES
  • Maintain excellent working relationship with the medical professional and other health related facilities and organizations.
  • Promote Company philosophy, mission, and objectives within and to customers outside the hospital.
  • Demonstrates ability to prioritize tasks/responsibilities and complete duties within allotted time. Willing to seek out new methods and principles and be willing to incorporate them into existing practices.
  • Demonstrates and understands the importance of and respect for the rights, dignity, and individuality of each patient in all interactions.
  • Demonstrates honesty and integrity at all times in the care and use of patient and hospital property.
  • Demonstrates respect for co-workers and responds to needs of patients by complying with hospital policies.
  • Demonstrates satisfactory level of interpersonal skills to interact and deal tactfully with facility staff, Administration, patients, families, customers, vendors, and government agencies.
  • Ability to carry out essential functions of this position with or without reasonable accommodation.
  • Access continuing education opportunities appropriate to responsibilities.
  • Appropriately accesses the resources of the company’ s corporate offices for consultation and program development support. Routinely shares professional knowledge with staff, managers, and hospital personnel.
  • Attend and participate in facility meetings.
  • Knowledge of emergency and disaster procedures of the facility.
  • Participate in hospital wide patient safety program identifying risks to patient safety and reducing healthcare errors.
  • Participates in relevant in-service training sessions.
  • Perform other duties as assigned.

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