Manager Case Management at AdventHealth
Date Posted: 5/20/2020
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1 - Day
Texas Health Huguley Hospital
Case Management Manager - Texas Health Mansfield- operated as joint venture between Texas Health Resources and AdventHealth
Location: 2300 Lone Star Road; Mansfield, TX
Top Reasons to Work at Texas Health Mansfield; Mansfield, TX
• Join a family of caregivers focused on whole-person health and committed to making communities healthier.
• Provide wholistic care for patients that extends to the spiritual level by praying with patients and families. Chaplains are available to meet with patients, families and team members 24 hours a day, 7 days a week to provide spiritual support.
• Help develop a brand new $150 million community hospital and medical office building that will provide services such as Medical/Surgical, ICU, Women’s Services, General Surgery, Orthopedics, Interventional Cardiology and Gastroenterology.
• Grow in your career with AdventHealth, named in 2018 by Becker’s Hospital Review as one of the “150 Top Places to Work in Healthcare”. AdventHealth has partnered with Texas Health Resources, named in 2019 as one of Fortune’s 100 Best Companies to Work For, to build Texas Health Mansfield, which is creating new opportunities for employment and professional growth.
• Thrive in the Mansfield community, ranked by CNN/Money Magazine as #17 for “Best Places to Live”. Mansfield is one of the fastest growing areas of North Texas, projected to reach more than 250,000 residents by 2023. Future job growth over the next ten years is predicted to be 41%, higher than the national average of 33.5%. Mansfield has top-rated schools, over 900 acres of parkland, quality housing, a historic downtown area, recreational opportunities for all ages, and a growing business community.
You Will Be Responsible For:
• Patient satisfaction scores meet organizational goals for HCAHPS.
• Strives to provide excellence in service to hospital staff, patients and families.
• Consistently assumes authority for department activity.
• Integrates the department services into the organization’s primary function.
• Reviews current professional standards for each program and makes recommendations for changes in policy, procedures, equipment, and assignments.
• Preparation of deliverables such as avoidable days, denial, and DRG options reports for the meetings as well as any other necessary reports.
• Manages the staff activities to ensure fulfillment of the institutional and program objectives.
• Establishes and implements department goals and outcomes with involvement of staff in accordance with Patient Business Services goals and the hospital’s strategic planning goals.
• Keeps staff informed of their responsibilities as well as activities and accomplishments of the hospital-wide programs.
• Demonstrates care for one another and respect for each person’s unique contributions.
• Serves as a clinical role model for staff. Maintains current skills &amp; knowledge base in Case Management
• Conducts regular scheduled and as needed staff meetings.
• Prepares and administers performance evaluation for staff.
• Interviews for positions and is responsible for hiring and terminating case management staff.
• Works to improve retention of staff.
• Ensures new staff receives complete orientation, as well as periodic review of progress toward independence.
• Conducts 30 &amp; 60-day new employee assessment, administers 90-day competency evaluation.
• Appraises and counsels staff to improve performance through meaningful, timely feedback and performance review.
• Consider factors related to patient safety, effectiveness, cost and impact on practice in the delivery of Case Management services.
• Daily oversight of utilization review activities to ensure compliance with Medicare and Medicaid as well as contractual agreements with Managed Care contracts.
• Ensures staff assign working DRG’s to establish geometric mean LOS, collaborate with CDIS staff to update working DRG as needed throughout the patients stay.
• Aware of and educates the staff to remain vigilant in tracking avoidable days, educate how it influences and improves discharge planning practice.
• Ensures concurrent denials addressed timely, keeps denial rate within benchmarks.
• Ensures staff compliance with EHR physician advisor referrals for second level reviews.
• Responsible to develop department budget. Monitors reports for variances and creates action plans as needed.
• Operates within designated budget to maintain expenditures within allocated funds, initiates actions to correct or seeks approval to maintain budget variances.
• Utilizes InterQual®ISD &amp; or Milliman criteria to ensure appropriate level of care settings.
• Passes Annual Inter-Rater reliability testing for InterQual®.
• Reviews monthly capitation reports.
• Responsible for payer contracts reporting of issues, and overall management.
• Maintains open dialogue with payers regarding utilization, case management, and discharge planning issues.
• Maintains positive relationships and communication with other providers to ensure staff awareness of services available and to ensure patient needs are met.
• Develops and maintains liaisons with local, state, and federal resources.
• Uses a cost containment approach in management and reports cost containment measures.
• Develops and implements policies and procedures that guide and support the provision of case management services and social work services across the continuum of care.