Slidell Memorial Hospital Director - Case Management - Slidell Market in Slidell, Louisiana

Director - Case Management - Slidell Market

Department:

Case Management

Schedule:

Full Time

Shift:

Days

Hours:

Job Details:

  • The Slidell Market Director provides leadership for the coordination of services through the continuum of care and direction in balancing quality patient care with cost effective utilization of resources for the Slidell Market (Slidell Memorial Hospital and Ochsner Northshore). The Slidell Market Director oversees the case management departments including staff, treatment and programs. Oversees a staff of Case Managers and Social Workers responsible for patient care coordination. Develops and implements case management programs, including utilization review and intake/discharge planning. Evaluates patient care data to ensure that care is provided in accordance with clinical guidelines and organizational standards. Seeks treatments that balance clinical and financial concerns with the family's needs and the patient's quality of life. Leads and directs the work of others. Maintains knowledge of Medicare, Medicaid, and other payor rules and regulations, particularly related to reimbursement. Maintains knowledge of CMS CoP's and The Joint Commission related to discharge planning and the continuum of care. Audits charts to ensure concurrent clinical reviews are performed timely for reimbursement from third party payors. Participates in meetings, committees, and continuing education to improve individual, departmental, and organizational performance. Institutes practice changes based upon findings from the monitoring and evaluation process. Developes and implements department strategic plan based on hospitals plans. Responds and adapts to changing expectations by altering goals and objectives, reprioritizing as necessary. Directs all departmental functions. Reports delays in care and quality and/or risk issues to the Managers of Quality, Risk and Medical Staff Quality Assurance Committee. Knowledgable in Interqual and Milliman. Knowledgable in RAC response. Develops Utilization Management Plan and completes annual appraisal of plan. Supervises Case Managers and Social Workers assigned to Case Management. Strong leadership skills, manages change well. Assigns avoidable days. Works closely with Data Analyst, Physician Advisors, CMO, and Director of QA/PI. Participates in Hospital QA/PI committee. Develops agendas for and coordinates Utilization Management Committee. Meets at least weekly with Case Managers to discuss challenging patients. Coordinates medical records for PA reviews. Participates with Case Managers in daily bed huddle activities. Maintains data base for avoidable days and other important Utilization parameters. Performs other duties as assigned or directed to ensure smooth operation of the organization. Preferred: Proficient in Word, Excel, and Powerpoint Required: Knowledge and use of Interqual and Milliman. Excellent interpersonal and written communication skills within the hospital and with outside agencies. Must be able to prioritize workload and develop efficient methods of managing time. Strong self initiative. Participates in counseling, guidance and education of personnel. Ability to use phone, fax and working knowledge of Outlook. Preferred: Master's Degree in Social Work. Required: Bachelor of Science in a related field. 5 - years clinical experience including three years of superviory and management experience in a clinical healthcare setting. Preferred: : Certified Case Manager Required: Current State of Louisiana Registered Nurse License or Licensed Clinical Social Worker