Job Summary

Oversees case management and utilization management functions in more than on Scion Hospital. Works in collaboration with RDCM and site DCM in the facilitation of care coordination through management of quality clinical service delivery. Identifies care management trends and discharge barriers for the coverage area through partnership with external customers, referral sources and payors to improve discharge planning and service to patients, family and the community. Supports site DCM to ensure that case management services comply with the Conditions of Participation. Collaborates closely with the hospital CEO/Administrator, COO, CFO, CCO and Regional DCM.

Essential Functions

• Provides support to ensure ongoing effective operations of the Case Management Department.
• Ensures regular, complete and timely reporting of case management performance outcomes.
• Represents and promotes ScionHealth Hospitals to the provider community and to local educational institutions, as appropriate.
• Participates as an adjunct management team member in the Value Driven Transition meeting and serves on other committees as needed and requested by site DCM and/or CEO.
• Identifies opportunities to achieve hospital goals based on available comparative data and benchmarks.
• Reviews and analyzes hospital utilization services statistics and provides site/area specific recommendations.
• Ensures areas of responsibility are operating in compliance with CMS, state and Joint Commission regulations and standards and with ScionHealth policies, including documentation and record requirements. Actively participates in surveys and audits.
• Provides support in onboarding process for new case management staff.

Knowledge/Skills/Abilities/Expectations

• Thorough knowledge of case management activities and requirements.
• Experience managing a variety of case management models using an interdisciplinary team approach.
• Ability to motivate and lead.
• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers
• Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
• Proficient in accreditation standards and compliance requirements.
• Ability to demonstrate critical thinking, appropriate prioritization and time management skills.
• Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Approximate percent of time required to travel 15%
• Must read, write and speak fluent English.
• Must have good and regular attendance.
• Performs other related duties as assigned.

Education

• Graduate of an accredited program required
• RN or BSN preferred
• Master's in social work with licensure as required by state regulations

Licenses/Certification

• Healthcare professional licensure required as Registered Nurse, Licensed Clinical Social Worker (LCSW),or Licensed Social Worker (LSW), as required by state.
• Certification in Case Management preferred.

Experience

• Minimum three years' experience in Hospital Case Management.

About Kindred Hospitals

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