Director Case Management - Glenwood Regional Medical Center

POSITION SUMMARY

Responsible for the direction of staff and fiscal resources of the Case Management Dept. Oversight of the hospital Case Management program.

• Provides direction and planning for physician advisor, and staff to establish priorities identifying trends. Develop short- and long-term goals for cost containment and reduction of LOS and utilization of hospital resources.
• Provides direction and planning for physician advisor, and staff to establish priorities identifying trends. Develop short- and long-term goals for cost containment and reduction of LOS and utilization of hospital resources.
• Develops structures and processes to facilitate participation by physicians, pharmacists, nurses, Social Workers and other health professionals in multidisciplinary care planning, care delivery, and discharge planning.
• Directs utilization review activities for the hospital, interfacing with external payers and review companies to determine appropriate medical necessity of admissions and continued hospitalization.
• Resolves conflicts related to discharge planning with patients/families, external agenand payers.
• Facilitates transition of patients/families across the continuum by establishing relationships with appropriate providers and community services
• Ensures compliance with DNV standards for the Continuity of Care function.
• Participates as a member of DNV Task Force.
• Establishes effective relationships with external agencies providing services to the organization (such as vendors, care providers, etc.)
• Effectively audits and monitors areas of responsibility for compliance issues. Promptly follows up on compliance issues. Creates an environment that encourages staff to report/resolve complicated issues.
• Employee is dependable and completes other assigned duties on schedule and these duties do not have to be redone.

QUALIFICATIONS

• Must be a graduate of an Accredited School of Nursing with a current La State Board License
• RN Case Management experience in an acute care setting preferred. Previous supervisory experience preferred.
• A current Louisiana license is required.
• Computer skills preferred.