Requisition ID: 62412

Location: Presence Mercy Medical Center

Location Address:
1315 North Highland, Aurora, IL 60506 United States (US)

Daily Hours: 8
Standard Hours: 40
Employment Status: Full-time
Employment Type: Regular
Shift: Day
FLSA: E

SUMMARY

The Manager Case Management manages and coordinates the professional staff and activities of care coordination. Ensures that the requirements stated in the Utilization Management Plan for the organization are completed and reported to the Utilization Management Committee, Administration, Medical Executive Committee, Medical Staff Quality Committee, and the Board of Directors.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Coordinates the activities and job responsibilities of the Case Managers and the Social Workers in the Case Management Department. Oversees departmental productivity and quality of work, identify areas for improvement, and develop and implement plans to correct issues.

Coaches and mentors staff to develop clinical and technical skills needed to attain performance goals. Assists staff in advancing their skills in care coordination, discharge planning, and performance of utilization reviews by providing guidance on problem solving, troubleshooting on difficult cases, and by intervening in agency/MD/insurance company issues. Provides ad hoc education (based on manager request or identified issue) for nursing related to case management, length of stay (LOS) and resource utilization and for the Case Managers in utilizing the principles and practices of patient flow so that patient care results in appropriate admission status and targeted LOS.

Develops and implements the processes that ensure that patients are placed at the appropriate level of service and that care for high risk patients is coordinated by Case Managers in collaboration with nursing staff and physicians in order to meet length of stay goals. Creates opportunities for interdisciplinary collaboration by identifying issues and contacting appropriate individuals/areas to facilitate resolution. Serves as a resource to Case Managers, nursing and medical staff for patients with complex care coordination and discharge needs.

Analyzes the case management model utilizing data, research, trends, and benchmarks to evaluate success based on length of stay, readmission reduction and denial reduction. Designs a model for case management that reflects current Best Practices and optimizes key clinical and financial outcomes of best practices within Presence Health and with external databases.

Assigns Case Managers to patient care units to maximize workflow and to ensure coverage of patient care areas. Oversees the self-scheduling activities of the Case Management staff, ensuring that services are available for patient care as determined by the department's scope of service.

Sets targets for length of stay, readmissions, and excess days and monitor results utilizing a case management scorecard based on national benchmarks to ensure established targets are met. Identifies any issues and recommend a plan for performance improvement.

Designs and implements quality reviews of the impact of Case Management activities on patient care, hospital performance, and collaboration with other professional disciplines and provide results to the Director, Physician Advisor, and UM Committee for decision-making purposes.

Develops and implements the strategic plan for the Case Management process and evaluate for effectiveness. Leads all appropriate department meetings relating to Case Management and facilitate brainstorming improvement opportunities regarding readmission, LOS, excess days, etc. Establishes, updates, and educates others on departmental policies, procedures, and department goals in support of the strategic plan

Promotes compliance with the Conditions of Participation and The Joint Commission standards relating to care coordination, utilization management, and discharge planning by networking with Case Management staff within Presence Health and with other hospitals to gather and provide updated information, guidelines, and standards for practice to the department.

Collaborates with Director in the development of operating and capital budgets by providing input on department needs such as phones, computers, supplies, use of external resources (i.e., Executive Health Resources {Physician Advisor group}), etc. Monitors budget, identify any variances, and resolve issues and/or refer to Director for resolution.

This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. Other duties may be assigned.

SUPERVISORY RESPONSIBILITIES

Does Not Supervise Employees

Directly supervises employee(s). Carries out supervisory responsibilities in accordance with the

organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

Bachelor's degree in Nursing, Hospital Administration or related healthcare field required. Minimum three years of progressively responsible case management experience in a hospital environment.

Master's degree in Nursing, Hospital Administration or related healthcare field preferred.

Computer Skills

Knowledge of Microsoft Office software, Meditech Order processing systems, and Kronos Payroll systems.

Certificates, Licenses, Registrations

Current Illinois RN licensure required.

Certified Case Manager (CCM) preferred.

Business Unit: Presence Mercy Medical Center

Job Function: Professional Services

COMPANY OVERVIEW:

EOE of Minorities/Females/Vets/Disability