Director of Case Management

Overview

Desert Regional Medical Center is a 385-bed acute-care hospital classified as a stroke receiving center and level 2 trauma facility with an innovative, patient centered and evidence-based Rehabilitation Services Department. Our compassionate team provides a wide range of inpatient and outpatient services, including acute care rehabilitation, joint replacement & spinal surgery, neurosurgery, ICU, Telemetry, step-down care, skilled nursing, as well as outpatient therapy, hand and lymphedema clinics.

The individual in this position has overall responsibility for operational management of the Case Management Department, Social Services and Bed Control; including staffing, budgets and plans. Responsibilities include, but are not limited to:

• Complying with relevant Tenet policies including Case Management and Clinical Determination Policies
• Implementing and revising the UM Plan and promoting cooperation with utilization review standards by the medical staff
• Maintaining / facilitating communication between the case management department and the physician advisor on a regular basis regarding utilization review and/or quality issues
• Maintaining / facilitating communication between the case management department and the physicians as well as other members of the healthcare team
• Analyzing reports: LOS, avoidable days, disputes, Inter Qual and associated metrics
• Responsible for implementation and compliance with all policies and regulations relating to the functioning of the case management department
• All other duties as assigned

Attends a workshop webinar led by PMI Case Management leadership or designee that includes the Tenet Case Management Model and other topics specific to role and responsibilities.

Information used to perform job: patient data, healthcare staff documentation related to patient care, regulatory and payor requirements, budgetary and operations data

Software used to perform job: eCCM:
Clinical data interface, Inter Qual, Case Management documentation, secure faxing, Avoidable Day tracking, Patient Medical Record and HPF, hospital specific Clinical Software, Enterprise Reporting:
Decision Support reports, PMI reports, Care Discovery, Position Control

Priority
1. Oversee coordination of clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post-acute care) compared to evidence-based practice, internal and external requirements. (40% daily, essential)

Priority
2. Oversee department operations (staffing, scheduling, education, budget etc). (20% daily, essential).

Priority
3. Perform data gathering, analysis and reporting. (20% daily essential).

Priority
4. Remain current with relevant clinical/ case management practices. Attend and participate in meetings related to Quality, Operational and Financial improvement (20% daily, essential).

All staff assigned to department (case managers, social workers, case manager assistants, administrative assistants). Other responsibilities as assigned e.g. disaster preparedness

The metrics below provide an indication of the effectiveness of the individual in this role and may be used for evaluative purposes. The list below is not meant to be exhaustive; other relevant metrics may exist.

• Compliance with Tenet Case Management policies
• Obtaining valid physician order prior to bed placement

Responsibilities

DEPARTMENT SPECIFIC DUTIES:

• Inter Qual reviews
• Observation hours
• Excess Days/ALOS
• Clinical disputes - incidence and dollars
• Number and type of avoidable days
• Resource Utilization
• At least 5 hours of CEUs per year on topics related to Case Management.

POSITION

QUALIFICATIONS:

Required:

• Registered Nurse with a BSN and an RN License
• Extensive management and clinical experience
• Experience in improving organizational performance
• Experience in facilitating and leading multidisciplinary teams
• Strong written and verbal communication skills
• Demonstrated ability to organize and work with groups of people
• Ability to present data to professional groups and institute changes based on the data presented
• Demonstrates effective problem solving and decision-making skills
• Minimum of 3 years of experience as a case manager

Preferred:

• Registered Nurse with a BSN and a California RN License

While performing the duties of this job, the employee is regularly required to sit, talk, and hear. The employee is frequently required to use fine motor skill (typing/data entry), and reach with hands and arms. The employee is frequently required to stand; walk; and occasionally stoop, kneel, or crawl. The employee must regularly lift and /or move up to 20 pounds and occasionally lift and/or move up to 50 pounds.

Individual works in both a clinical and office environment.

Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof…