RN Director, Case Management

RN Director, Case Management College Hospital Costa Mesa - 1.0 Costa Mesa, CA Job Details Full-time $55 - $65 an hour 9 hours ago Benefits Health savings account Health insurance Dental insurance 401(k) Flexible spending account Tuition reimbursement Paid time off Employee assistance program Vision insurance 401(k) matching Life insurance Qualifications Collaborate with healthcare professionals RN License Customer service Case management Recruiting Delegation Nursing Full Job Description Psychiatric hospital in Orange County is looking to hire a full-time Director of Case Management Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for

CHCM/CSU

roles, including but not limited to shift differential and other special pay practices, etc. The posted compensation for the position is a reasonable estimate that extends from the lowest to the highest pay at

CHCM/CSU

in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.

• After applying through Indeed, please visit our website at chcm.us to download our application. Send your completed application and resume to our HR email address. Thank you
• Listed below is the job description :

STATEMENT OF PURPOSE

The Director of Case Management is responsible for oversight of all activities performed by Case Managers, Social Workers, and associated clerical staff. The Director implements the Utilization Management Plan for the organization and coordinates with Multi-Disciplinary team accordingly. ____________________________________________________________________________________________________________

QUALIFICATIONS

Maintains current license as RN in the State of California. Masters Preferred. Must have at least three years directly related work experience. Must have adequate training and experience in Case Management including thorough understanding of the criteria/guidelines associated with the decision making process. Must have a working knowledge of county social services and mental health systems. Must demonstrate ability to effectively liaison with Management, Physicians, and line staff.

PHYSICAL DEMANDS

Frequent sitting for long periods of time, walking and standing. Occasional bending, crawling, and reaching. Occasional lifting up to 25 pounds. Occasional pulling and pushing up to 50 pounds. Corrected vision and hearing to a normal range. Finger dexterity. Frequent exposure to stressful situations. Occasional contact with patients and public.

WORKING CONDITIONS

Occasional exposure to noise, dirt, dust, smoke and fumes. Occasional exposure to bloodborne pathogens. Occasional exposure to chemicals and general cleaning agents. Occasional driving.

MAJOR TASKS, DUTIES, AND RESPONSIBILITES

(All duties listed below are essential to the job.)

• General Management Accountabilities
• Manager's conduct conforms to the Management Principles, Mission, Vision, Values, and Code of Conduct of College Hospital.
• Provides timely & objective feedback on employee job performance before or within two weeks of performance evaluation due date; rewards exemplary behavior; administers performance improvement plans including disciplinary action as necessary.
• Documents on-going staff meetings, orientation and in-service training activities.
• Effectively protects all health information from unauthorized access per HIPAA regulations and all applicable local and state laws.
• Demonstrates compliance with all applicable standards of regulatory agencies by developing & maintaining policies, procedures & criteria based job descriptions that comply with applicable regulatory & accreditation agencies.
• Demonstrates the ability to forecast annual budgets for staffing and departmental needs; maintains department monthly expenditures; takes appropriate action to adjust accounts during the budgeted year, i.e. overages.
• Demonstrates the ability to keep up with the demands of the position: delegates responsibilities appropriately.
• Demonstrates the ability to make sound judgments by identifying, assessing, and communicating appropriately.
• Demonstrates the ability to effect, implement and maintain changes.
• Demonstrates & communicates support for Administration's goals & directives, and responds to required Administrative deadlines.
• Attends and participates in required management meetings and seminars.
• Demonstrates continual professional development: maintains required certifications for position; interviews and selects qualified employees in accordance with current criteria based job descriptions.
• Attends to personal affairs to avoid any interference with productivity.
• Demonstrates an understanding of the Hospital's Fire/Disaster Safety Manual by knowing personal as well as departmental role in the case of a code; has oriented staff to such.

DIRECTOR OF CASE MANAGEMENT - CASE MANAGEMENT/UTILIZATION REVIEW PAGE 2

• General Management Accountabilities (cont'd)
• Functions with an awareness of patient safety issues and applies basic principles of safety as identified within the facility. Ensures that staff follows the occurrence reporting policy and procedure in reporting any potential safety issues.
• Job Specific Duties
• Provides Case Management services in a timely, professional, and comprehensive manner so as to set the standard for the department.
• Responsible for assuring the accomplishment of departmental objectives by overseeing Case Management services hospital-wide. Able to assess resources (i.e., staffing needs, office space, technical needs) and take appropriate actions based on the assessment.
• Oversees and directly recruits, trains, and supervises staff and evaluates ongoing employee performance.
• Develops and implements the organization's utilization management plan in accordance with the mission and strategic goals of the organization, federal and state law and regulations, and accreditation standards. Educates physician, leadership, and staff as to the utilization management plan and their respective responsibilities relative to the plan, when required.
• Demonstrates the ability to prepare statistical data and reports for formal presentations ; to include, the analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process.

Coordinates, evaluates, and revises the Case Management performance improvement plan, providing relevant and comprehensive utilization data on a timely basis. Prepares and presents quality control summaries to appropriate committees, identifying potential areas for improvement.

• Develops and implements systems to ensure compliance with case management policies and procedures.
• Keeps Chief Operating Officer informed of departmental activities, needs, and problems.
• Demonstrates knowledge and expertise to assist staff in assessing clinical appropriateness of treatment plans, lengths of stay, and services delivered.

Provides direction for problematic cases and is able to direct staff accordingly.

• Develops training material for hospital-wide in-services.
• Collaborates consistently with the Director of the Business Office to ensure timely reimbursement for all payors.
• Responsible for management of denial process for all payor sources.
• Combines ethical judgment and clinical skill with knowledge of legal, social, and economic considerations when making Utilization Management decisions.
• Demonstrates knowledge of organizational, governmental, accrediting and third party regulations as applicable to Case Management.

Maintain familiarity with Medi-Cal criteria, Medicare criteria, and health plan specific criteria. Maintain knowledge of the process of conservatorship and discharge planning guidelines (to include, but not limited to patient qualifications for discharge setting and the criteria for administrative time based on setting).

• Performs other duties as assigned.
• Communication
• Demonstrates a sense of pride and enthusiasm in the Case Management Department, providing inspiration and leadership to staff.
• Able to communicate in a positive, professional manner and supports effective working relationships at all levels.
• Consistently assess current processes within the department and make sound recommendations for continuous processes improvements in a positive, proactive manner.
• Able to take a leadership role in communicating and collaborating with practitioners across settings to formulate and execute a common care plan.

Able to identify and suggest appropriate interventions for key patient related issues and facilitate the flow of critical information among the clinical team. Works closely with the medical staff and leadership to identify patient care trends and issues.

• Customer Service
• Exhibits behavior that is courteous, compassionate, polite, friendly, and respectful towards patients, visitors, physicians, and co-workers and extends self to make patients, visitors, clinical staff, and peers feel welcome and respected.

Reports to:

Chief Executive Officer Pay:

$55.00 - $65.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Flexible spending account Health insurance Health savings account Life insurance Paid time off Tuition reimbursement Vision insurance People with a criminal record are encouraged to apply

Work Location:

In person