Registered Nurse (RN) - Case Management
Excela Health
Butler, PA

Director, Case Management

Job Summary/Overall Objectives The main primary responsibilities include but not limited to: provision of clinical case management services, provision of social services to patients/families, and coordination of day to day operations of the Clinical Resource Management (CRM) department. The role assumes responsibility to develop, implement and evaluate the strategic plan for the organization-wide case management process. The Director provides operational supervision for a staff of case managers responsible for patient care coordination and establishes tools, processes, and systems to optimize the Case Manager role. The Director oversees Social Workers, Utilization Review and Denial Management staff. Develops and implements care management programs, including utilization review, intake and discharge planning, and managed care contracting/authorizations or negotiation. The Director will enhance, implement and oversee a case management/ CDI strategy and process that is data driven, physician led, evidence based, team oriented and patient centered with the objective reduction of cost, length of stay, readmissions, and revenue enhancement. Evaluates patient care data to ensure that care is provided in accordance with clinical guidelines and organizational standards. Essential Job Responsibilities * The position is responsible for leading the department and accountable for Clinical Resource Management Department. * This position has direct supervisory responsibilities such as hiring, coaching/mentoring, skills development, recognition and rewards, staff productivity, performance management and succession planning. * Equitably and consistently apply and practice policies and procedures for all staff. * Develop and manage department budget at or below budget expectations and consistent with adjusted volume variations. * Identify and implement revenue enhancement opportunities. * Practice and encourage staff readiness in compliance with agency regulations and guidelines. * Interpret laws, policies, operational procedures, and objectives. Ensure compliance with regulatory and legal requirements. * Models excellence in practice through knowledge and communication with the medical staff and health care team to ensure timely coordinated patient care and market for the organizational success of Independence Health System. Serves as the lead resource, educator and advocate for all patient care services provided within the scope of services of the Clinical Resource Department and preadmission testing departments, and as directed through the hospital Utilization Review. Plan. Develops strategic plans, goals and objectives for the department ensuring compatibility with hospital goals and direction, which are supported by documented policy and procedures. * Responsible to administer fiscal oversight to the department's operations, as well as case management's responsibilities within the scope of the organizational fiscal plan. Prepares and administers departmental budgets, incorporating short- and long-range plans. Including payer negotiation, authorization, clinical documentation initiatives in coding/DM assigned CMI. Denial management opportunities, resource management; awareness of the many reimbursement strategies of the various payers is key to department/organizational success. Assumes overall responsibility for management of UKG/API to support time/attendance and approve overtime hours when appropriate based upon volumes. * Proactively assesses the impact of the ever-changing health care environment of responsibility and effectively implements change to meet needs while successfully motivation staff to accept change. Adjusts actions to achieve positive outcomes, responds to organizational and department change and applies resolution techniques as a positive tool for growth/goal attainment. Can be relied upon to follow problems through to solution, seeking out opportunities for participation in special projects. Facilitate transition of patients across the continuous post-acute services. * Participate on assigned medical staff, executive and corporate committees; promote effective communication between departments and entities, act as a liaison to facilitate information, sharing, collaborative problem solving and adequate provision of support services; foster and maintain collaborative relationships within the hospital and the Health System, and with external agencies related to quality and performance initiatives as well as day to day operation issues that may arise. * Collaborate with administration, management, and educational resources to develop mechanisms for staff development and to make appropriate changes as needed to keep department current with new regulations, policies and trends in the Case Management field. Create a system for initial and ongoing education and development of staff. * Establish effective communication systems and forums with third party payers and the local PRO. * Develop and maintain effective relationships with hospital department heads, nursing managers and administrators, and the administrative staff. Develop and/or contributes to an effective outcomes management process. Establish effective relationships with external agencies providing services to the organization (such as vendors, care providers, etc.). * Facilitate transition of patients/families across the continuum by establishing relationships with appropriate providers and community services. Provide leadership to multidisciplinary groups as organized by the facility. * Create processes to anticipate and address specific situations within the department, including long stay patients, post-acute resource referral lists, denials, and termination of benefits. Identify improvement opportunities within the department and at the system level and create strategies to address them. * Establish, implement, and evaluate a strategic plan for the department that takes into account internal and external factors. Effectively communicate the plan throughout the organization. * Other duties as assigned. Competency and Experience [Knowledge, Skills and Abilities] Required Qualifications/Experience * Graduate of an Accredited Nursing Program * Bachelor's Degree or higher in related field and five (5) years in an acute care setting and experience in utilization, review/case management, progressive leadership. * Five (5+) years supervisory/management experience in functional area. * Strong leadership ability, good organizational skills, independent and critical thinking skills, sound judgment, and knowledge of legal aspects and liability of functional area. * Strong ability to communicate complex and/or controversial topics and concepts to a wide and diverse audience. Preferred Qualifications/Experience * Master's Degree in Nursing or related field preferred. * Experience in Healthcare setting. * National Certification in area of specialty preferred. * Certification as an Accredited Case Manager, Certified Case Manager or Case Management Administrator. License, Certification & Clearances * Current Licensure to practice as a Registered Nurse in the State of Pennsylvania. * Act 34-PA Criminal Record Check from the PA State Police system. Position Type/Expected Hours of Work * Incumbent will be scheduled based on operational need (rotate shifts, standby, on-call, etc.). * Travel may be expected locally between System locations. Equal Employment Opportunity Independence Health and its affiliated companies are Equal Opportunity Employers. It is their policy to prohibit discrimination of any type and to afford equal employment opportunities to employees and applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, disability, veteran status, or genetic information, or any other classification protected by law. Independence Health and its affiliated companies will comply with all applicable laws and regulations. Disclaimer This job description is not designed to contain a comprehensive listing of all activities, duties or responsibilities that are required of the employee. Moreover, duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. Work Environment Effective March 2020 or during pandemic: goggles, face shield and mask are required according to CDC guidelines Work Environment Effective March 2020 or during pandemic: goggles, face shield and mask are required according to CDC guidelines When lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required. Essential - Absolute Necessity. Marginal - Minimal Necessity. Constantly - 5.5 to 8 hours or more or 200 reps/shift. Frequently - 2.5 to 5.5 hours or more or 32-200 reps/shift. Occasionally - 0.25 to 2.5 hours or 2-32 reps/shift. Rarely - Less than 0.25 hours or less than 2 reps/shift. Physical Condition Essential Marginal Constantly Frequently Occasionally Rarely Never Extreme Heat X Extreme Cold X Heights X Confined Spaces X Extreme Noise(>85dB) X Mechanical Hazards X Use of Vibrating Tools X Operates Vehicle (company) x Operates Heavy Equipment X Use of Lifting/Transfer Devices X Rotates All Shifts X 8 Hours Shifts X X 10-12 Hours Shifts X X On-Call X Overtime(+8/hrs/shift; 40/hr/wk) X Travel Between Sites X X Direct Patient Care X Respirator Protective Equipment X Eye Protection X Head Protection (hard hat) X Hearing Protection X Hand Protection X Feet, Toe Protection X Body Protection X Latex Exposure X X Solvent Exposure X Paint (direct use) Exposure X Dust (sanding) Exposure X Ethylene Oxide Exposure X Cytotoxic (Chemo) Exposure X Blood/Body Fluid Exposure X Chemicals (direct use) Exposure X Mist Exposure X Wax Stripper (direct use) X Non-Ionizing Radiation Exposure X Ionizing Radiation Exposure X Laser Exposure X Physical Demands When lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required. Essential - Absolute Necessity. Marginal - Minimal Necessity. Constantly - 5.5 to 8 hours or more or 200 reps/shift. Frequently - 2.5 to 5.5 hours or more or 32-200 reps/shift. Occasionally - 0.25 to 2.5 hours or 2-32 reps/shift. Rarely - Less than 0.25 hours or less than 2 reps/shift. Physical Condition Essential Marginal Constantly Frequently Occasionally Rarely Never Bending (Stooping) X X Sitting X X Walking X X Climbing Stairs X X Climbing Ladders X Standing X X Kneeling X Squatting (Crouching) X X Twisting/Turning X Keyboard/Computer Operation X X Gross Grasp X X Fine Finger Manipulation X X Hand/Arm Coordination X X Pushing/Pulling(lbs. of force) X <10# Carry X <5# Transfer/Push/Pull Patients X Seeing Near w/Acuity X X Feeling (Sensation) X Color Vision X X Hearing Clearly X X Pulling/Pushing Objects Overhead X Reaching Above Shoulder Level X X Reaching Forward X X Lifting Floor to Knuckle X <10# Lifting Seat Pan to Knuckle ### X Lifting Knuckle to Shoulder ### X Lifting Shoulder to Overhead ### X

When lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required