Resource Director of Case Management Full Time

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

• Serves as a subject matter expert in case management, offering operational expertise within the case management departments across multiple Scion Health hospitals
• Oversees the functions to coordinate, negotiate, procure services for, and manage the care of complex patients with all health team members throughout the facility
• Patient population served range in age from 18 years to geriatric experiencing medically complex conditions, general medical-surgical conditions with rehabilitation and/or wound care needs
• Integrates Case Management within the hospital’s primary functions, policies and procedures and standards of practice in a manner that contributes to the provision of comprehensive health care and achievement of quality cost effective outcomes

Essential Functions 

• Plan, coordinate and implement programs for the case management department
• Manages programs and resources to maximize patient outcomes
• Trains and retains qualified competent staff to provide case management and related series to attain or maintain highest practicable physical, mental and psychosocial well-being of each patient
• Assures new employee orientation, regular performance reviews, and reviews job actions taken by subordinates to assure that the staff meets qualification and performance standards and can perform all essential functions of their job
• Reviews staffing plans to ensure sufficient numbers of qualified staff according to budgeted funds
• Assess, plan, develop, implant and evaluate all performance improvement activities within department
• Provide ongoing education to staff on performance standards
• Develop culture of “100% compliance 100% of time.”
• Collect and analyze outcomes and submit reports to regulatory agencies, administration, UR and MEC Committees
• Develop, implement and maintain policies and procedures that reflect current standards of practice for case management and consistent with all state, federal and TJC regulations
• Communicates directly with patients, families, medical staff, nursing staff, interdisciplinary team members and department heads to coordinate care and services, improve organization and implementation of patient care to maintain quality of care
• Evaluates patient outcomes and revises plan according to changes in patient needs
• Manages customer’s perceptual outcomes effectively and responds timely.
• Assess patient’s condition, learning needs and family dynamics based on systematic data collection utilizing assessment skills and tools appropriate to the respective practice area
• Develops a comprehensive plan of care and discharge plan based on the nursing assessment and integration of the medical plan utilizing patient’s family and other health care team members
• Overall management of staff compliance with value focused documentation process, plan of care and patient and family education
• Participates in budgetary process
• Submits proposals related to departmental budgetary staffing and planning
• Provide relevant financial information to the CEO/RCMD regarding financial needs and status.
• Retain current with literature related to department and maintain an updated methodology, tools, manuals and criteria as necessary and appropriate

• Attends all required hospital meetings

Knowledge/Skills/Abilities/Expectations

• Approximate percent of time required to travel:  100%
• Must have good and regular attendance
• Must read, write and speak fluent English
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations
• Ability to effectively present information and respond to questions from supervisors, patient or family, physicians and public
• Ability to apply common sense understanding to carry out instruction furnished in written, oral and/or diagram form
• Ability to define and solve problems, collect data, establish facts and draw valid conclusions
• Ability to interpret an extensive variety of technical instructions in statistical or diagram form and deal with several abstract and concrete variables
• Demonstrates active listening techniques
• Gains support through effective relationships
• Treats others with dignity and respect; seeks feedback
• Attends in-service and education programs
• Attends continuing education required for maintenance of professional certification or licensure
• Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals
• Ability to compute rate, ratio, percent as well as the ability to create and interpret graphs
• Ability to project a professional image
• Knowledge and experience with ICD 10 - CM Codes
• Knowledge of reimbursement under PPS system
• Possess in-depth knowledge of functions of the Case Management Department and performance improvement requirements as outlined by TJC, the Department of Health for the State of employment and Federal regulatory standards as outlined by Centers for Medicare and Medicaid (CMS)
• Knowledge of hospital policies and procedures
• Working knowledge and ability to apply professional standards of practice in job situations
• Strong organizational and analytical skills
• Demonstrates critical thinking skills
• Working knowledge of computer and software applications used in job functions, (order entry, data entry)
• Able to carry out the essential functions of this job (with or without reasonable accommodations)
• Supports staff, patient and family education to enhance knowledge, skills, and necessary behaviors to facilitate positive outcomes
• Seeks out external resources through conferences, workshops, etc. as necessary
• Shares professional knowledge with staff, managers and hospital personnel
• Demonstrates and understands the importance of and respect for the rights, dignity, and individuality of each patient in all interactions
• Demonstrates respect for co-workers and responds to needs of patients by complying with hospital policies
• Promote the philosophy, mission and objectives of the Company within and to customers outside the hospital
• Demonstrates satisfactory level of interpersonal skills to interact with facility and medical staff and Administration, patients, families, customers, vendors and government agencies
• Assure participation in relevant in-service training sessions, facility meetings and continuing educational opportunities appropriate to responsibilities
• Demonstrates honesty and integrity at all times in care and use of patient and hospital property
• Demonstrates ability to prioritize tasks/responsibilities and complete duties within allotted time
• Appropriately accesses the resources of the Company’s corporate offices for consultation and program development support
• Participate in hospital wide patient safety program identifying risks to patient safety and reducing healthcare errors
• Comply with HIPAA regulatory requirements
• Performs other related duties as assigned

Pay Range: $114,000 to $170,000/Year

ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness.

Education

• Graduate from an accredited School of Nursing, BSN preferred or LMSW

Licenses/Certification

• A Registered Nurse, preferred, or a Licensed Masters Social Worker who is currently licensed to practice by the state of employment is required
• CCM credential highly preferred
• Must maintain current Healthcare Provider BLS Certification throughout employment

Experience

• Three (3) years’ experience as a Case Manager in an acute care hospital, health care provider, or managed care company
• Prefer case management experience in an acute hospital