Director/Case Management-FT-Days-Case Management (UNIVERSITY
Company: Methodist Lebonheur Healthcare
Posted on: February 23, 2021
Job Date: Jan 13, 2021 Location: Memphis, TN, US Summary The
Director of Case Management leads a collaborative case management
effort by coordinating the care and services of patient populations
at the assigned facility. Provides clinical leadership for the care
management team by serving as an educator, role model, patient
advocate, and change agent to achieve optimal clinical, financial,
and resource outcomes. Oversees daily team activities and provides
strong leadership through training, coaching, teaching and managing
assigned teams. Models appropriate behavior as exemplified in MLH
Mission, Vision and Values. Education/Experience/Licensure
Education/Formal Training Work Experience Credential/Licensure
REQUIRED: BSN or BS in healthcare-related field. Five (5) years'
clinical nursing experience required. Two (2) years' experience in
care coordination, case/care management, utilization/resource
management, quality management or transitions of care required.
Demonstrated leadership skills gained through previous
supervisory/management experience. Current license as an RN in the
state where work is performed, or compact license. Certified Case
Manager (CCM) or Accredited Case Manager (ACM). PREFERRED: Master's
degree is preferred. N/A SUBSTITUTIONS ALLOWED: N/A N/A Must pass
the CCM or ACM certification upon qualification for the exam, with
the certification complete within one year from date in the job.
- Working knowledge of discharge planning, utilization
management, case management, performance improvement, and managed
- Strong understanding of pre-acute and post-acute venues of care
and post-acute community resources.
- Demonstrates advanced conflict resolution and problem solving
skills for timely resolution of issues.
- Communicates clearly and professionally in both oral and
- Demonstrated ability to develop and maintain working
relationships with physicians and work collaboratively with health
professionals at all levels to achieve established goals.
- Knowledge of quality improvement tools and metrics to assess
and manage case management goals.
- Understanding of regulatory/compliance requirements such as
UM/URAC and CMS conditions of participation.
- Demonstrated excellent facilitation skills.
- Strong organizational and time management skills as evidenced
by capacity to prioritize multiple tasks and roles.
- Intermediate to advanced computer skills; experienced with
Microsoft Word and Excel. Knowledge of EMR systems and case
management software and tools.
- Ability to use initiative in decision-making, independent
judgment, and critical thinking skills. Key Job Responsibilities
- Provides clinical guidance and supervision to all case
management programs, based on accepted principles of nursing,
social work, and case management practice.--
- Provides leadership to the interdisciplinary team to achieve
optimal outcomes through the tools of care management.
- Collaborates with stakeholders to continually streamline,
standardize, and systematically implement best practice case
management processes, including interfaces with revenue cycle.
- Develops and implements case management programs, including
utilization review, intake, and discharge planning.--
- Manages and monitors department activities to evaluate the
productivity and quality of programs and processes in order to
identify potential improvements and ensure maximum
- Develops and administers budgets for operational areas,
authorizes expenditures, and monitors budget and other financial
indicators. Assists in the development and implementation of plans
to control costs and improve department operations.
- Develops and maintains professional networks and relationships
with hospitals, physicians, community resources, and other
providers to promote continuity and quality of care.
- Uses a collaborative approach with physicians and the
multidisciplinary team to facilitate care and eliminate barriers
for the designated case load. Ensures that the plan of care and
services provided are patient focused, high quality, efficient, and
cost effective. Seeks care plans that balance clinical and
financial concerns with the family's needs and the patient's
quality of life.
- Uses data to drive decisions and plan/implement improvement
strategies related to case management for assigned patients,
including fiscal, clinical, and patient satisfaction data.
- Initiates and leads the development, implementation,
evaluation, and revision of clinical pathways.
- Ensures that policies and procedures are developed and enforced
in alignment with standards of patient care and regulatory bodies,
and that the core components of case management processes are
- Works in collaboration with other key stakeholders to remain
current on regulatory requirements. Participates in the development
of standardized processes to fulfill compliance with all CMS and
regulatory agencies' statutes/standards specific to utilization
- Serves as a resource to the corporate and facility Revenue
Cycle teams as well as Corporate Compliance for any/all denials
including all pre and post pay audits related to utilization
management. Serves as an active participant in the appeals process.
- The physical activities of this position may include climbing,
pushing, standing, hearing, walking, reaching, grasping, kneeling,
stooping, and repetitive motion.
- Must have good balance and coordination.
- The physical requirements of this position are: medium work -
exerting up to 50 lbs. of force occasionally and/or up to 25 lbs.
of force frequently.
- The Associate is required to have close visual acuity including
color, depth perception, and field of vision to perform an
activity, such as assessing patients, preparing and analyzing data
and figures; transcribing; viewing a computer terminal; or
- Occasional invasive and non-invasive patient contact.
- Exposure to patient body fluids as well as exposure to
hazardous or poisonous materials.
- Ability to react quickly to emergency situations.
Keywords: Methodist Lebonheur Healthcare, Memphis , Director/Case Management-FT-Days-Case Management (UNIVERSITY, Executive , Memphis, Tennessee
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