Job Description

Category:
Management/ Professional

Facility:
Corporate

Department:
Revenue Management

Req Number:
49998

Job Details:

POSITION SUMMARY:

The Corporate Director of Case Management and CDI is responsible for strategic direction and operational leadership for all case management and CDI activities across Steward Health Care's Central Division as well as high level operations, ongoing quality, productivity and consistency of processes. Maintains corporate relationships both within and outside of Steward. Other responsibilities include strategic planning, development and implementation of operational plans, education and collaboration with physician leaders, facility leaders and service line leaders including but not limited to HIM, Audit & Appeal, physicians/clinicians, Revenue Operations.

The Corporate Director of Case Management and CDI will have direct oversight of multiple locations. Day-to-day responsibilities will include CDI procedures, patient discharge procedures, community service accessibility, and identification of potential barriers to patient treatment. Additional responsibilities include operational oversight, managing department budgets, quality assurance, corporate compliance, and developing department goals. This role will maintain consistent case management, utilization review, and CDI processes throughout Steward Health Care System.

The hospital Directors of Case Management and CDI will have a dotted line to the Corporate Director.

KEY RESPONSIBILITIES:

* Develops integrated case management and CDI programs:

· Evaluates current services and identifies needs and opportunities for quality improvements and increased consistency across facilities.

· Develops policies and procedures to support integration and effectiveness.

· Leads efforts to develop comprehensive programs.

· Works closely with Physician Advisors.

· Provides guidance to providers regarding clinical documentation, utilization review process, results interpretation and identifying needs.

· Participates in the evaluation of community resources utilization.

· Negotiate contracts with facilities and vendors as necessary for patient continuum of care.

· Standardizes Utilization Review and CDI Committee plans, agendas, and committee participants under direction of the CMO.

· Ensures information systems are in place to support programs and reporting

· Coordinates evaluation of software packages and makes recommendations.

· Maintain appropriate educational training for computer systems with Department Directors.

· Work with liaison in IS department to develop department specific reports for daily workflow and data collection.

· Coordinates disease management efforts:

· Ensures that appropriate protocols are being developed to support disease management programs.

· Develops disease management committees.

· Participates with CM Directors in interdisciplinary teams to institute system-wide supports for disease management initiatives.

· Work in collaboration with insurance carriers to promote Disease Management programs to medical staff for appropriate referrals.

· Provides educational regarding managed care programs and CMS:

· Develops and delivers case management and CDI principles to physicians, staff and others.

· Work with physician leadership to educate physician staff on an ongoing basis about changes to managed care and CMS regulations.

· Develops case management and CDI organization:

· Develops organization and staffing plans with Directors.

· Defines new positions and involved in hiring CDI and Case Management Directors.

· Oversees the work of directors and providers for the ongoing development of performance.

· Assists with the development and manages budget.

· Develops a database, which quantifies and tracks ongoing initiatives resulting from third party payment issues.

· Work with Directors and department leaders to increase quality of patient care.

· Case Management and CDI Duties:

· Act as a resource for all Directors and staff.

· Educate nursing staff and ancillary departments about multidisciplinary care rounds and documentation.

· Establish consistent processes across Steward facilities related to LOS huddles, multi -disciplinary rounds, short stay hospitalizations and other relevant processes.

· Travel to the Steward Health Care System Florida, Pennsylvania, and Ohio facilities. Up to 75% travel expectation.

Performs related and unrelated responsibilities, as needed.

REQUIRED KNOWLEDGE & SKILLS:

*

· Knowledge of TJC requirements

· Knowledge of quality assurance, standards compliance, and outcome management

· Knowledge of external medical case management programs

· Knowledge and application of reimbursement guidelines

· Knowledge of payment/reimbursement systems

· Knowledge of patient rights and commitment to patient advocacy

· Knowledge of ICD-10 coding

· Effective educator skills

· Excellent written and oral communication skills

· Effective crisis management skills

· Effective team leadership skills

· Ability to collect, document, and analyze data

· Understanding of claims submission process

· Word processing and data entry skills

· Network access to community, state, and national resources and health services organizations

· Application of budgetary skills

· Ability to effectively manage staff

· Ability to prioritize and work in concert with the facility CEO and medical staff

· Ability to assist in training activities

· Demonstrates effective resource management

· Demonstrated experience and competency in working with individuals and groups

Application of counseling skills in interpersonal behaviors and conflict resolution

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

* Education: BSN preferred.
* Experience (Type & Length): Minimum of five years management experience in a hospital related healthcare environment required. Three years of case management/utilization review or related experience required.
* Certification/Licensure: Current RN licensure in MA in good standing. Certification in clinical documentation.
* Software/Hardware: Meditech; MS Office.



Application Instructions

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