Director of Case Management

Position will provide ongoing support and expertise aligned with strategic plan to guide us through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. The overall goal of the position is to enhance the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integrating and functions of case management, utilization review and management of discharge planning. Accountable for the care, coordination and discharge planning of all patients.

Promotes the mission, vision and values of the organization

Assists in developing specific departmental goals, standards and objectives which directly support strategic plan and vision of the organization. See the detailed Leadership Responsibilities outlined below that outline Strategic Planning, Leadership, Human Resources Management, Financial Management, and Performance Improvement/Safety.

Coordinate the integration of social services/case management function into the patient care, discharge, and home planning processes with other hospital departments, external service organizations, agencies and healthcare facilities.

Conduct concurrent medical record review using specific indicators and criteria as approved by medical staff, TJC, CMS and other state agencies. Acts as patient advocate: investigates and reports adverse occurrences, and performs staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery.

Mobilizes resources and interviews, as needed, to achieve expected goal to assist in achieving desired clinical outcomes within the desired timeframe.

Ensure that patient test are appropriate utilization of services from admission through discharge.

Evaluate patient satisfaction and quality of care provided.

Initiates and presents "denial letters", as appropriate

Asses patient care required throughout continuum of care for diagnosis, procedures and DRG's

Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship.

Assist physicians to maintain appropriate cost per case and desired patient outcomes.

Introduces self to patient and family and explains clinical case manager role and process for patient and family to contact clinical case manager.

Facilitates interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post-hospital needs.

Collaborates with clinical staff in the development and execution of the plan of care, and achievement of goals.

Directs and participates in the development and implementation of patient care policies and protocols in order to provide advice and guidance in handling special cases or patient needs.

Coordinates the provision of social services to patients, families, and significant others to enable them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from healthcare services.