The Director of Case Management is responsible for assuring that patients seen at CHRISTUS St. Vincent Regional Medical Center (CSVRMC) are done so in as safe, effective and efficient manner as possible as such he/she will work closely and collaboratively with Case Management, Utilization Management, Bed Control, Performance Improvement, Revenue Cycle Departments and members of the Medical Staff.
Implements the practices of:
Daily patient assessment, review, and proactive discharge planning in collaboration with the case management staff
Assists in the development and/or modification of standard order sets and pathways
Conducts utilization management and review
Participates in a collaborative manner in the monitoring of quality of care measures
Identifies avoidable days and developing action plans to reduce them
Promotes the goals, objectives, and benefits of comprehensive case management and coding involvement to the medical staff
Actively participates and educates physicians to achieve the appropriate level of care
Actively participates in the development of physician performance measures as it relates to patient throughput on medical/surgical, observations, and critical care areas
Actively participates in medical necessity denials and appeals
Actively participates, when consulted, in other activities within scope of expertise.
Collaborated with hospital clinical managers, plans, organizes and coordinates clinical functions and activities to achieve objectives and facilitates compliance with regulatory requirements
Mentoring and developing staff on competencies and effectiveness of Case Management
Monitoring staffing and productivity levels and standards per hospital initiatives.
EDUCATION: Graduate of an accredited school of nursing. BSN required, MSN/MBA preferred.
CERTIFICATION/LICENSES: Current licensure in New Mexico for RN applicants. Case Management Certification preferred.
SKILLS: Ability to work collaboratively with patients, physicians, co-workers and community. Ability to function effectively as a member of LeadershipTeam. Must be able to read, write and speak English fluently. Ability to speak Spanish desirable. In addition, the following skills are desirable:
Knowledge of database management
Knowledge of clinical information systems
Solid understanding of finance and accounting principles
Excellent communication and listening skills
Works well in team settings
Utilization review experience
Knowledge of managed care
EXPERIENCE: Five years of related experience with performance improvement programs and clinical education, case management, and/or care path implementation, including at least three years of management/supervisory experience; or an equivalent combination of related education and experience. Five years of clinical nursing experience in a hospital setting. Excellent organization, communication and teaching skills.
NATURE OF SUPERVISION:
-Responsible to: Chief Financial Officer
- Bloodborne pathogen -- A -
Limited hazards. Typical office and hospital surroundings. Close contact at least by telephone.
PHYSICAL REQUIREMENTS: Light. Able to operate computer equipment, Standing walking.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.