System Director of Case Management
Company: Air Combat Effectiveness Consulting Group, LLC
Location: Alhambra
Posted on: January 27, 2023
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Job Description:
Overview
Primary Function
The Systems Director of Case Management oversees the operations of
the Case Management Departments and provides guidance and
leadership in the planning, implementation, and support of the
organization-wide Case Management Departments. The Systems Director
of Case Management is accountable for coordinating the ongoing
development and productivity of the Case Management Departments at
AHMC Healthcare facilities, as well as meeting established
performance metrics for Case Management operations. The Systems
Director of Case Management focuses on Length of Stay (LOS),
concurrent denials, and performance metrics.
Responsibilities
Nature and Scope (Essential Functions)
--- Ensures established metrics of the Case Management Departments
at the designated facilities are met and works closely with local
leadership of Case Management to achieve established goals.---
Demonstrates advanced knowledge of DRG, Value-Based, Risk-Based,
and Per Diem payment methodologies.--- Knowledgeable in the
application and compliance of State and Federal regulatory
requirements pertaining to Case Management and Utilization Review
Process.--- Ensures that staff adheres to the rules and regulations
of all local, state and federal guidelines and to the standards of
accredited bodies.--- Compiles, interprets and develops action
plans around data and analytics.--- Oversees, mentors, and develops
CMS leaders at the Director, Manager, and supervisory level, as
well as works collaboratively with hospital leadership at the local
level to address and improve identified issues timely.--- Works
with the facilities leadership teams, medical directors, Case
Management Departments, and Utilization Management to set
short-term and long-term goals.--- Provides leadership and
supervision to facility staff.--- Assesses needs, plans,
communicates, and implements services that are applicable based on
the facility policies, procedures, and protocols.--- Maintains
Prospective Payment System, monthly case log and other files needed
for peer review organization and specific needs of the hospital.---
Demonstrates knowledge of standard utilization screening tools.---
Discusses denial of coverage related to Utilization Review with
appropriate leaders. Assists with on-site monitoring reviews by
outside review organizations and third-party payers.--- Creates and
implements systems of communication between other departments and
facilities that increases the efficiency and effectiveness of the
Case Management process.--- Develops and implements long-term
strategies for the organization leveraging emerging healthcare, and
business trends and collaborates with the local leadership teams
and clinical leaders to deliver strategic business value.---
Assumes a sponsorship role for Case Management initiatives in
partnership with CEO's, CMO's, CNO's, and CFO's aligned with
standardized best practice measured by key performance
indicators.--- Facilitates communication between staff, management,
vendors, and other resources within the Healthcare System.---
Develops responsive decision support and analysis capabilities to
provide for data driven decision making by leadership--- Leads a
visible and transparent project prioritization process to align
resources with initiatives and to ensure interdisciplinary efforts
are in support of organizational strategic priorities.--- Fosters a
customer service- focus, culture throughout the organization, and
is viewed as a change leader throughout the organization.---
Commits to ongoing professional knowledge and awareness of
healthcare trends and serves as a Case Management advisor to the
organization.--- Takes accountability for the organization's Case
Management performance and operations and ensures a capable and
competent Case Management team at each facility.--- Performs other
duties as assigned or required.
Qualifications
Qualifications
Minimum of 8 years of experience with increasing responsibilities
for management and support in Case Management. Minimum of five
years' experience in Hospital Case Management.
Bachelor's degree in clinical area required. Bachelor of Science in
Nursing preferred.
Healthcare professional licensure required as a Registered
Nurse.Appropriate certification in Case Management preferred.
Previous experience in a hospital environment as Director of Case
Management or as highest-ranking leader in Case Management.
The ideal candidate will also have:
--- Documented project management experience using a variety of
methodologies for the planning, implementation and support of
systems in a complex health care environment.--- Familiarity with
operating systems such as Windows.--- Knowledge of various office
productivity software programs such as word processing, databases,
spreadsheet programs, and communications software. --- Ability to
analyze and resolve complex issues, both logical and interpersonal.
--- Effective verbal and written communications skills and
effective presentation skills, all geared toward coordination and
education. --- Ability to negotiate and defuse conflict. ---
Self-motivator, independent, cooperative, flexible, creative. ---
Current driver's license; ability and willingness to travel when
necessary.
Hospital Description
AHMC consists of a corporate office and seven acute care hospitals,
and one skilled nursing facility, AHMC Anaheim Regional Medical
Center 228 beds, Garfield Medical Center with 211 beds, Greater El
Monte Community Hospital with 115 beds, Monterey Park Hospital with
102 beds, San Gabriel Valley Medical Center with 273 beds, Seton
Medical Center with 357 beds, Seton Medical Center Coastside a
116-bed skilled nursing facility, and Whittier Hospital Medical
Center with 172 beds. The facilities are Medicare and MediCal
certified and accredited by the Joint Commission on Accreditation
of Healthcare Organizations. The hospitals provide healthcare
services reimbursed by Medicare, MediCal, traditional insurance
plans, PPO, HMO and under capitated arrangements.
Keywords: Air Combat Effectiveness Consulting Group, LLC, Alhambra , System Director of Case Management, Executive , Alhambra, California
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