Director Care Management, Care Management - FT (Days) - $10,000 Sign on - PHH

Job Number: 120024

Piedmont Henry Hospital - Stockbridge, Georgia
Shift/Schedule: Full-time


Description

JOB PURPOSE:

Organizes, directs and supervises the functions of the Care Management Department, assuring that policy and procedures are followed; proper qualified staffing levels are maintained; supplies and equipment are at sufficient levels; that an efficient department is integrated with the other departments in the hospital. The director is responsible for the development and implementation of the department’s budget. The director will assure ongoing performance improvement, encouraging educational improvement and assuring employees complete required yearly forums, for reviews and competencies. The director develops, evaluates, initiates, consults and advises the hospital in regard to performance and quality improvement and JCAHO standards related to case management. The director participates in committees with the hospital medical staff to address and resolve issues. The director continually updates processes for monitoring and managing cases under all types of insurance.

 
KEY RESPONSIBILITIES:

1. Directs overall department activities and program development to achieve utilization, financial, and service goals through effective communication and role modeling.

2. Assesses and provides staffing needs within budget constraints.

3. Directs the development of progressive departmental goals and objectives incorporating progressive Care Management strategies.

4. Facilitates the development, implementation, and achievement of department goals and outcomes using measurements to determine trends.

5. Set goals and objectives for dept., which are consistent with the hospital mission. Designs action plans to achieve goals.

6. Develops, updates, and implements policies and procedures for staffing, job responsibilities, and all other aspects of dept.

7. Prepare and submit annual budget timely. Monitor approved budget and other financial data to control costs.

8. Maintain dept. and regulatory manuals; maintain insurance guidelines and medical necessity criteria.

9. Oversee quality improvement activities for UR and Discharge Planning services.

10. Coordinates reconsiderations and appeals with other depts, physicians and UR Committee.

 

 

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Requirements

 
MINIMUM EDUCATION REQUIRED:
Bachelors Degree required.

MINIMUM EXPERIENCE REQUIRED:
Two (2) years clinical experience that directs and evaluates patient care.

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
Licensure in the State of Georgia as a Registered Professional Nurse is required.

ADDITIONAL QUALIFICATIONS:
Masters Degree, preferred. Previous utilization review experience preferred with knowledge of managed care systems and various review criteria.

 KNOWLEDGE, SKILLS, ABILITIES
 Skill and ability to communicate effectively both verbally and in-writing.
 Skill and ability to handle multiple priorities and deadlines.
 Ability to work as a member of a team.
 Skill and ability in Microsoft Office applications.
 Knowledge of monitoring and evaluation techniques with previous judgment and decision-making preferably in a utilization management/case management position.
 Ability to analyze and interpret data; knowledge of management practices and procedures; knowledge of budgetary process and/or development; knowledge of administrative and operational process; and knowledge of JCAHO regulation.
 Able to demonstrate effective interpersonal skill through verbal and written communication to promote cooperation from health care team, providers, payers, patients and their families.
 Proficient oral and written communication skills are needed.

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