System Director-Case Management Social

Supervision:

• Directs the Case Management Department, Pastoral Care, Palliative Care Program, Physician Advisory and Foreign Language Interpretation/Translation
• Oversees the functions of insurance certification, utilization review, psycho-social assessment/intervention, care coordination (continuum from acute care stay to post acute), and specified quality data collection
• Administrative collaboration in analyzing analytics for length of stay, readmissions, transition of care, inpatient/outpatient compliance, chronic disease and population health management
  
  Consulting:
• Works with Compliance Officer in achieving and maintaining compliance with Federal and State Guidelines
• Assists Chief Medical Officer with enhancing the quality, efficiency, and efficacy of patient safety and care
• Acts as a consultant to all clinical, medical , and support staff
• Assists Compliance Officer and HIS Director/VP of Revenue Cycle in auditing record requested by third party auditors to determine the feasibility of filing an appeal.
• Medical Ethic Committee participation/oversight
• Acts as a consultant to ITS for Case Management software and clinical guidelines
  Reports/Recordkeeping:
• Reports physician generic quality screens, non-acute days, insurance denials, length of stay, and resource utilization issues to appropriate personnel
• Maintains and updates records of accreditation of referral agencies and facilities
• Maintains accurate records of psycho-social assessments/interventions, care coordination and insurance certification utilization review activities
• Reports activities and outcomes to management, medical staff, service lines and Board Members
• Maintains tracking of post acute referrals and transitions of care trends
• Ensures that required reporting of suspected abuse and/or neglect is carried out timely and appropriately
  Customer Services:
• Provides support for Service Lines
• Maintains working relationship with physicians, professional staff, and members of the Healthcare team
• Resolves care connections and/or grievance
• Collaborates with Patient Experience/DOP on HCAPS improvements
  Liaison:
• Serves as a liaison between Hospital and Health Systems of Mississippi, Blue Cross and Blue Shield of Mississippi, Centers for Medicare Medicaid (CMS), Information and Quality HealthCare (IQH), State Department of Health,  United Way, Healthcare Foundation and various other third party managed care payors
  Budget:
• Responsible for preparing, submitting, implementing and controlling the Case Management Budget(s) across the system facilities, and Pastoral Care.
• Makes recommendation for budget needs across the system to facility Administrators
• Assist administration with the allocation process for bundle payments, value based payment models, for acute care and post acute care patient population
• Responsible for collaborating with physicians and the physician advisory’s on a daily bases to continually monitor length of stay, certification and denial compliance.
  
  Regulatory:
  Ensures compliance with departmental and regulatory agency guidelines
  
  Job Knowledge:
• Currently licensed as a Registered Nurse or Social Worker by the State of Mississippi
• Master’s Degree in Nursing, Social Work or related field required
• Certification in Case Management preferred; required; or will to obtain within 6  months of hire
• Certification from a Council on Social Work Education (CSWE) accredited school preferred if employee holds a Social Work degree
• Experience in budgeting, financial analysis, goal setting, and personnel management, preferred
• Five years or more of experience in a management role in a health care setting, preferred
• Interaction with a patient population of all ages ranging from neonates to geriatrics, required
• Three years experience in the area of hospital Case Management, Social Services, or Utilization Review is required
• Must possess a working knowledge of State and Federal regulations and guidelines in the area of responsibility
• Interaction with a patient population of all ages ranging from neonates to geriatrics within the scope of Case Management, required
• Computer and typing skill required.
• Excellent written and verbal communication required

Licenses