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Job Objective: A brief overview of the position.
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The RN-Manager Business Operations is responsible to provide support and leadership over side of the Case Management department planning, organizing and directing the daily operations such as staffing, assignments, kronos, performance evaluations, and competencies. This position will work closely with the RN-Clinical Manager-Case Management and Social Worker Manager to ensure the daily operations of the department are met
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Reports to
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Director of Case Management
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Supervises
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RN-Care Coordinators and Care Coordinator Liaison
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Ages of Patients
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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: BSN
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Preferred: MSN or MBA
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Licensure/Certification
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Required: CA RN License
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Experience
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Required: 3-5 year experience in Case Management field
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Required: 2 years of experience in Acute Hospital Case Management field
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Preferred: Previous managerial experience
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Preferred: Case Management Certification
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Essential Responsibilities
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Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
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Rounds with Case Managers and Case Manager Assistants to guide and advice on best practice of the Case Management of patients.
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Participates in Interdisciplinary rounds to support the Case Management needs of patients.
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Reviews Outlier patients and discusses with interdisciplinary team, medical necessity, active discharge plan, discharge barriers, avoidable delays capture for process improvement opportunities. Keep log of patients up to date for performance improvement opportunities and escalates as needed.
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Rounds with Case Managers to review OBS patient over 18 hours for process improvement opportunities. Educates staff as to best practices.
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Supports patient throughput activities in the movement of patient through the continuum of care.
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Works closely with payers in addressing concurrent stays denials and support the PEER to PEER review process.
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Provides Physician Education pertaining to CM best practices.
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Provides Resident education on 2 midnight, CM processes and proper documentation to prevent clinical denials.
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Provides oversight of clinical orientation of new Case Managers and Case Manager Assistant.
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Provides clinical feedback to operations manager regarding Case Managers and Case Manager assistant performance.
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Maintains department performance improvement program; promotes and supports department and hospital wide performance improvement efforts.
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Ensures compliance with regulatory requirements and with policies and procedures.
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Maintains knowledge of and compliance with laws, regulations (federal and state) as well as JC accreditation standards and contractual agreements pertaining to Case Management.
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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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Rounds on outlier or complex patients to ensure we are meeting their needs and or question/concerns are addressed.
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Participates and supports the improvement in the following Case Management Department key performance indicators:
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Patient Satisfaction
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Physician Satisfaction
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Employee Satisfaction
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Financial Performance on LOS and Denials.
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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 performance issues.
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Develops and implements corrective action plans proactively when process and other issues are identified.
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Provides ongoing training and education to keep Case Management staff abreast of changes including updates on new regulations, specific expectations and outcome requirements.
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Maintains the Case Management Department in a state of constant readiness in regards to TJC and State survey review:
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Completed 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 providing training and mentorship of the latest regulation by CMS on:
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Medicare 2 midnight rule
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Patient Choice
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IMM Notices
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Moon Notices
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Discharge planning regulations
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HINN notices
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Ensures that staff consistently provides high quality patient care and/or other support services that are valued by patients, physicians and each other.
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Role models the organization’s values.
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Participates in hospital activities and committees as appropriate.
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Evaluates departmental performance and effects changes as needed to improve services. Keeps administrative records and information of education activities, improvements and interventions to resolve educational deficiencies.
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Demonstrates compliance with Code of Conduct and compliance policies and takes action to resolve compliance questions or concerns and reports suspected violations.
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Performs other duties as assigned.
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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.
