Job description

Regional Corporate Director of Case Management
The Regional Corporate Director of Case Management (RCDCM) serves as the central resource to the Corporate DCM assisting with oversight of the development, implementation, evaluation and support of system operational and strategic initiatives as related to Case Management, Utilization Management and CM Clinical Documentation Integrity (CDI) functions in assigned regional facilities/area(s). The Regional CDCM champions organizational, division, and facility initiatives to ensure short term and long term objectives are operationalized within assigned regions(s). The Regional DCM reports to the Corporate Director of Case Management. This is an exempt position.

I. Essential Functions

• Provides support to and actively participates with facility Director of Case Management to identify, implement, or enhance Case Management activities consistent with system, region and facility strategy
• Assesses Case Management and Utilization Management performance in assigned facilities/regional area(s)
• Assists with the identification of best demonstrated practices and shares both regionally and system-wide
• Assists with development, implementation and education for new and/or revised policy and procedure, regulatory and payer updates
• Regional accountability to ensure compliance and/or adherence with regulations, policy and procedure, and associated clinical and quality initiatives related to Case Management and Utilization Management
• Regional accountability for data analysis of identified case management metrics; develops, implements and monitors action plans when benchmarks are not met; educates and mentors facility case management staff on interpretation of data and the performance of casual analysis
• Facilitates and assists with new and on-going Case Management education within the Region; provides or facilitates specific education related to case management and/or other identified initiatives
• Regional accountability for onboarding, orienting, and training of new DCM’s in regional hospital start-ups, acquisitions and other areas as directed
• Provides direct leadership for case management staff during Director of Case Management vacancies in assigned region
• Performs routine site visits to validate compliance with state and federal regulatory requirements; organizational policy and procedures and to assist in identifying areas of opportunity for growth and staff education.
• Provides input on utilization management activities with a focus on quality outcomes, length of stay management, medical necessity and resource utilization effectiveness, clinical documentation integrity
• Participates in research and development of electronic medical record updates related to case management documentation and activities
• Collaborates with Directors of Case Management of assigned region in reaching facility and organizational goals including length of stay, denials, care transitions, and avoidable readmissions, patient experience, and other quality initiatives
• Performs other assigned duties as designated

II. Leadership

• Inclusiveness: Promotes cooperation, fairness and equity; shows respect for people and their differences; works to understand perspectives of others; demonstrates empathy; brings out the best in others and in his/her team
• Managing Staff: Coaches, evaluates, develops, and inspires staff; sets expectations; recognizes achievements; effectively manages conflict; aligns department goals with organization goals; provides feedback; delegates appropriately; evaluations completed on time
• Stewardship and Resource Management: Demonstrates accountability and sound judgment in managing company resources; appropriate understanding of confidentiality and company values; adheres to and supports company policies, procedures and safety guidelines
• Problem-Solving: Identifies problems and involves others in seeking solutions; conducts appropriate analysis and searches for best solutions; effectively and efficiently implements appropriate responses to correct problems; responds promptly and effectively to new challenges
• Decision-Making: Makes clear, consistent decisions; acts with integrity in all decisions; distinguishes relevant from irrelevant information; makes timely, appropriate decisions.
• Strategic Planning and Organizing: Understands company vision and aligns priorities accordingly; measures outcomes; uses feedback to redirect as required; evaluates alternatives; appropriately organizes complex issues to desirable resolution
• Communication: Connects with peers, subordinate employees and all customers; actively listens; clearly and effectively shares information; demonstrates effective oral and written communication skills; negotiates effectively.
• Quality Improvement: Strives for efficient, effective, high-quality performance in self and in the department; delivers timely and accurate results; resilient when responding to matters that are challenging; takes initiative to make improvements
• Leadership: Motivates others; accepts responsibility; maintains high morale in department; develops trust and credibility; expects honest and ethical behavior of self and staff
• Teamwork: Encourages cooperation and collaboration; builds effective teams; works in partnership with others; is flexible; responsive to the needs of others
• Development: Maintains up-to-date skills through involvement with professional organizations and/or continuing education

III. Customer Service

• Maintains the highest level of customer service via courtesy, compassion and positive communication
• Promotes the Mission and Vision of Post Acute Medical within the work environment and the community
• Respects dignity and confidentiality by adherence to all applicable policies and procedures

IV. Health and Safety

• Works in a manner that promotes safety; wears clothing appropriate to the performance of the job
• Participates in OSHA required training
• Follows universal precautions as appropriate for position; complies with Employee Health requirements for continued employment
• Reports unsafe practices to management
• Knows own role in case of an emergency

POSITION QUALIFICATIONS:

Education and Training: RN licensure in the state where the hospital resides; BSN/MSN preferred. Certification in an approved Case Management Program preferred. Current BLS certification required. CCDS certification is an asset.
Minimum Work Experience: Three to five years of recent case management, utilization review/management experience required. Prior experience in IRF or LTACH setting preferred. Prior experience in clinical documentation improvement, quality management, and/or coding beneficial. Prior management experience preferred.
Required: Ability to travel approximately 50-75% of time.
Required Knowledge, Skills, and Abilities:

• Knowledge of CMS Conditions of Participation Guidelines for Discharge Planning, Utilization Review and other areas as related to Case Management and Utilization Management
• Advanced knowledge of utilization management principles, concepts, and strategies including admissions criteria, levels of care, and denials
• Advanced knowledge of commercial insurances, Medicare, Medicaid, and State/Federal regulations; payer eligibility; reimbursement regulations and impact on the continuum of care
• Knowledgeable regarding InterQual, Milliman, and/or decision support criteria
• Knowledge of nursing and case management, standards based practice, shared governance, organizational initiatives, in terms of theories and practices to serve as a resource and educator to others
• Knowledgeable regarding DRG/CMG assignment and reimbursement
• Knowledgeable regarding coding guidelines & conventions as applied in CDI is an asset.
• Basic Microsoft Windows desktop application and navigation skills
• Effective leadership skills
• Effective written and verbal communication skills
• Strong quantitative, analytical, and organizational skills
• Organizational and time management skills, as evidenced by capacity to prioritize multiple tasks
• Ability to work in a collaborative model with all members of the interdisciplinary team, both internal and external
• Maintain current knowledge of case management, utilization management, and discharge planning, as specified by organization, federal, state and private insurance guidelines.

Job Type: Full-time

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