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Job Description: A brief statement of the position, including the general job duties.
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Provides leadership for the administration, direction and ongoing development of the Case Management department. Is responsible for ensuring that appropriate utilization of resources is accomplished through efforts that are cost effective, safe, clinically appropriate, and enhance quality of care. Promotes and facilitates appropriate admission status, and facilitates movement through the healthcare continuum by implementing processes that ensure timely and proactive care coordination and discharge planning. Integrates department services with other departments and medical staff initiatives.
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Reports to
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Senior Director-Health System Quality
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Supervises
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Care Coordinators, Social Services, Discharge Planners, Discharge Planning Associates, Utilization Review staff Managers and Coordinators
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Ages of Patients
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None
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Blood Borne Pathogens
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Minimal/ No Potential
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Qualifications
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Education
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Required: Bachelor’s degree in Nursing
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Preferred: Master’s Degree in Health Related field
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Licensure/Certification
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Required: CA RN License
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Experience
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Required: 3 years experience in Case Management field and minimum 3 years previous managerial experience
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Preferred: 5 years in Case Management and 5 year’s previous managerial experience
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Specific Skills, Knowledge, Abilities Required
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Supervisory/management experience, preferable in the area of case management
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Well developed organizational and communication skills.
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Ability to develop and direct all elements of Case Management process within the hospital system.
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Knowledge of regulatory, state and federal guidelines pertaining to Case Management processes and continuum of care strategies.
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Well developed critical thinking and problem solving skills
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Knowledge of Case Management and Social Services roles and processes.
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Essential Job Specific Responsibilities
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Demonstrate an improvement in the following Case Management Department key performance indicators:
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Physician Satisfaction
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Employee Satisfaction
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Productivity Targets
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Appropriate Admit Status
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Appropriate use of Observation
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Reduction in RAC Risk
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Denials overturned
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Financial Performance
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Maintains the Case Management Department in a state of constant readiness in regards to JCAHO and State survey review:
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Completes baseline assessment.
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Develops action plans for areas with need for performance improvement.
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Monitors and measures quality and current state of action plan implementation.
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Develops a high performing team by:
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Recruiting qualified and experienced staff.
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Educating staff on specific expectations and outcome requirements of the work they perform.
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Ensuring that the staff has the resources necessary to meet objectives and expectations.
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Developing and implementing an orientation/mentoring program for the department.
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Developing and educating staff in order to implement and maintain an immediate service recovery program.
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Providing outcomes analysis and process measure reports of department specific key performance indicators.
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Demonstrates accountability for job responsibilities and actions taken by embracing the obligations stated in the job description by taking initiative and ownership of the job responsibility tasks.
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Develops and implements corrective action plans proactively when process and other issues are identified.
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Implements, integrates and maintains department performance improvement program and promotes and supports hospital wide performance improvement efforts.
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Collects, analyzes and presents data to Case Management staff, Vice President, Clinical Resource Management and to other departments and committees as appropriate.
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Participates in, promotes and supports hospital wide Performance Excellence program and efforts.
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Provides support and administrative leadership for the Utilization Management Committee.
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Monitors and reports quarterly quality, satisfaction and outcome data that is aligned with organizational goals and service standards regarding the Case Management program.
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Develops, maintains and provides initial orientation and ongoing training and education to promote Case Management for medical, clinical and departmental staff.
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Collaborates and coordinates with the Quality Improvement Department, Decision Support and Medical Staff Services in the completion of focused studies, as requested, for Case Management related issues.
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Manages Case Management Department human resource activities in accordance with Hospital policies and procedures.
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Acts as a liaison to community resources and professional associations to promote the performance improvement of Case Management and patient/family/physician satisfaction.
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Maintains knowledge of and compliance with laws, regulations (federal and state) as well as JCAHO accreditation standards and contractual agreements pertaining to Case Management.
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Enforces and makes recommendations regarding contractual agreements pertaining to Case Management
- Participates in hospital activities and committees as appropriate.
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Located in the heart of the Coachella Valley, you have access to resort-style living and world-class amenities throughout Southern California.
