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Job Summary: The Case Management Director directs the Case Management and Utilization Management activities in a Kindred hospital. Oversees the faciltation of care coordination of the patient and family through the management of quality clinical service delivery. Partners with external customers, referral sources and payors, to ensure the facilitation and coordination of the discharge planning process and serves as the patient and family advocate. Accountable for the facilities Denial Management Program. Ensures that case management services comply with the Conditions of Participation, Collaborates closely with the hospital CEO/Administrator, COO, CFO, CCO and Regional Office.
Oversees coordination of patient care to facilitate development, monitoring and refinement of treatment plan to achieve identified patient goals and outcomes. Assumes responsibility for ongoing, effective operations for Case Management. Supervises employees involved in concurrent and retrospective utilization review activities and the identification of discharge planning needs.
Communicates effectively with nursing and other ancillary departments to ensure proper utilization and documentation.
Provides mechanisms to monitor and enforce compliance with CM program. Ensures regular, complete and timely reporting of case management performance outcomes. Assures that the clinical programs are responsive to the needs of payors, patients and families.
Represents and promotes Kindred to the provider community and to local educational institutions when appropriate.
Ensures the development of standards and case management practices are integrated and are consistent with current research, professional standards and regulatory requirements affecting patient care.
Assures that the clinical programs are responsive to the needs of payors, patients and families. Designs, implements and monitors process to assure optimal utilization of resources and reimbursement.
Participates as a management team member in the Utilization Management Committee Presents reports to Utilization Management Committee, Quality Council, Medical Executive Committee and Governing Board as required.
Identifies opportunities to achieve average length of stay targets based on available comparative data and benchmarks. Aggregates and analyzes hospital utilization services statistics and recommends corrective action, if required.
Ensures areas of responsibility are operating in compliance with CMS, State and JCAHO regulations and standards and with Kindred policies, including documentation and record requirements. Actively participates in surveys and audits.
Graduate of an accredited program required.
RN or BSN preferred; OR Masters in Social Work with licensure as required by state regulations; OR Bachelors in Social Work with licensure as required by state regulations
Healthcare professional licensure required as Registered Nurse, OR Licensed Clinical Social Worker (LCSW) OR Licensed Social Worker (LSW), as required by state.
Appropriate certification in Case Management preferred.
Minimum three years experience in Hospital Case Management.
Job:Case Mgmt/MDSPrimary Location:CA-Santa Ana-Kindred Hospital - Santa AnaOrganization:4825 - Kindred Hospital - Santa AnaShift:Day