Director of Case Management/Swing Bed Coordinator

Description:

JOB SUMMARY AND SCOPE

Job Location will be at Calais Community Hospital and Down East Community Hospital The Director of Case Management is accountable for the organization, sequence of services, and resources that are necessary and appropriate for the achievement of patient outcomes within effective time frames on a specific group of patients. The Director of Case Management must have ability to practice under minimal supervision and to perform the following six essentials of

Case Management:

Appropriateness of setting, Assessment, Planning, Implementation, Coordination, Monitoring and Evaluation with emphasis on decreasing length of stay and monitoring of cost effective health care across the continuum of care. This position is required to have competence to assess and case manages the age groups as indicated. The Director of Case Management evaluates patients for appropriateness, medical necessity, intensity of service, severity of illness, and performs continued stay reviews according to Interqual Acute Care Criteria. The Director of Case Management must meet resource management expectations, assist to reduce practice variations, and enhance patient outcomes. In addition the Director of Case Management serves as the Swing Bed Coordinator.

ESSENTIAL JOB FUNCTIONS

Coordinate the care and services of selected patient populations across the continuum of illness Promotes effective utilization through reviews of Medicare, Medicaid, self-pay, and commercial insures admissions Provide a leadership role with the interdisciplinary team to achieve optimal outcomes Ensure timely discharges through early assessment and development of a discharge plan with early identification of barriers to discharge Communication with physicians, staff, patient/family, outside agencies to provide continuum of care Responsible for maintaining the Case Management Policy and Procedure Manual with annual review and updates as needed Responsible for writing policies and procedures for the Case Management Department Performs continued stay reviews using InterQual Criteria Verifies that all inappropriate admissions, unnecessary continued days, and procedures not meeting approved indications are forwarded to physician advisor Issues notices of non-coverage to patients and families as required within Medicare and Medicaid guidelines Conducts formal and informational staff education to all disciplines related to case management Identifies opportunities for intradepartmental and interdepartmental operational improvements Responsible for quarterly case management meetings to include formulating agenda and conducting the meeting Adheres to the organizational leadership profile Reliable attendance and punctuality Performs duties in a safe manner, in compliance with all safety policies and procedures Complies with the Code of Conduct and all appropriate policies and procedures Other duties, as assigned, that are relevant to the position and department

Requirements:

MINIMUM REQUIREMENTS

Current State of Maine RN License Diploma or BSN from School of Nursing At least three years clinical experience in an acute care hospital setting preferably in the areas of discharge planning, utilization review, and resource management Good organizational and leadership skills, excellent interpersonal skills Working knowledge of Microsoft Word, Microsoft Excel, and Microsoft Power Point, Knowledge of Interqual Acute Care Criteria, Knowledge of Medicare and Medicaid rules and regulations Ability to prioritize tasks and manage time efficiently, ability to function autonomously, ability to educate members of healthcare team and other customers

PHYSICAL EFFORT AND ENVIRONMENT

Moderate:

Occasionally lifts up to 25 pounds independently. Stands or walks often. Talking and hearing essential for conferring with patients, families, and staff.

EXPOSURE RISK

Exposure Category II:

Employee reasonably expected to be at some risk for exposure to blood borne pathogens.

QUALITY IMPROVEMENT

Maintains current knowledge of the hospital-wide Quality Improvement Program. Develops and implements appropriate quality improvements for the department. Develops quality initiative projects and the methods necessary for initiating, testing, data collection, analysis, and reporting the effectiveness of the project. Establishes indicators to monitor departmental service in response to complaints, identified problems, variances, sentinel events, or new services as well as patient outcome oriented indicators for high volume and/or high risk services. Reports all Quality Improvement activities, measurements and results according to the established reporting structure. Participates in the annual review of the Quality Improvement/Patient Safety Program. Participates as a member of functional and/or process improvement team as appropriate to position or requested. Provides Quality Improvement orientation, training, and continuing education for all departmental staff. Involves all departmental staff members in the Quality Improvement Program's plans and processes. Is accountable for identification and mitigation of risks and hazards within the department.

COMPLIANCE

Adheres to the federal, state, and local statutes and regulations. Adheres to the Compliance Program policies and procedures of Down East Community. Adheres to all Privacy and Security policies and procedures of Down East Community. Communicates any concern related to compliance issues to Compliance Officer. Communicates any concern related to confidentiality issues to the Privacy Officer. Educate, train, and supervise staff on all related compliance issues. DECH is an equal opportunity employer.