Regional Director of Case Management job, NM

BSN with superior leadership experience to lead case management in a highly matrixed and integrated healthcare system.  Expert knowledge of CMS Conditions of Participation related to Discharge Planning and Utilization Management, knowledge of reimbursement methodology, clinical trajectory of care, and hospital throughput and care coordination throughout the continuum.

Summary of Major Duties: Directs and manages the operation and activities of the Case Management Department, including Utilization Review, Social Work and Discharge Planning.  The Director is responsible for the overall management of the department’s daily operations to achieve quality improvement goals, fiscal productivity, patient satisfaction goals and objectives established by upper management. The Director has overall responsibility for staff performance and the development of departmental goals in accordance with the hospital, case management practice and regulatory requirements.  The Director collaborates with all disciplines, departments, payers, system partners, vendors and community agencies.
Reports to:  Population Health – Executive Director and Medical Director of Case Management
Coverage Area details/Assignment:

  • Main Hospital –Average Census: 450
  • Second hospital – Licensed beds – Average Census: 85
  • Third hospital 30 Bed Emergency Room and Short Term Care Post-Surgery unit coverage for discharge planning only.

Management/Admin team reporting to Director:

  • 4 RN Managers
  • 1 SW Manager
  • 1 Clinical Educator
  • 1 RN Auditor
  • 1 Administrative Support **shared with Medical Director
  • 1 Project Manager (reporting and metrics and process support)

Case Management Team:

  • Total of 70 front-line team members across campuses
  • Mixed model of RNs, MSWs and Health Service Assistants
  • **Utilization Management (first level reviews) are currently being outsourced

2016- Strategic initiatives:

  1. Build strong and cohesive management team – New Managers oriented mid to late 2015 or 2016 with varied experience in case management.
  2. Re-energize Complex Rounds – Implement process to address all issues causing extended stay, address avoidable causes and appropriate action and follow up.
  3. Discharge Redesign – Early Discharge Process – Using Daily Management System (DMS) approach, solidify standard work for case management in the redesign project.
  4. Assist in developing a plan/execution to Insource Utilization Management
  5. Triad Model- Division of Transition planning activities among team to support proactive transition planning
  6. Assist in EPIC Implementation of Clinical Case Management Module – 

    Contact:Tina Roberts, President
    588 Sutter Street, Suite 349
    San Francisco, CA 94102
    (415) 770-1200    (415) 684-2526

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