System Director of Case Management

Company: Air Combat Effectiveness Consulting Group, LLC
Location: Alhambra
Posted on: January 27, 2023

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