System Director Case ManagementJob ID 2019-5735 Shift Days FTE 1.0 Start/End of Daily Work Schedule M-f 8:00 am-4:30 pm Type Full Time Facility Prince George's Hospital Center Department 136975-Case Management
Under the general direction of the Chief Nursing Officer, the Director, Case Management is responsible for the management, leadership, coordination, productivity and operation of system-wide case management services including, but not limited to Case Management, Discharge Planning, Denials and Appeals Management, Utilization Review, Quality and Peer Review. The Director is responsible for the active involvement of multiple disciplines and professional staff to reach departmental and organization-wide clinical, financial, and quality targets of performance. The Director acts as a liaison and an advisor for community resources and agencies to support ongoing success of the department. The Director must appropriately manage people, relationships, and processes among internal and external customers in order to achieve maximum results for UMCRH.
Effectively directs oversees and manages the processes of Case Management , Discharge Planning, Utilization Review, Quality and peer Review. Confers and consults with federal and state agencies on matters related to Case Management.
2. Plans and implements formal education sessions for Case Management staff on policies, procedures, regulations and mandates of federal and state agencies and Utilization and Quality Improvement Committee requirements.
3. Initiate and coordinates control systems to identify effort and assure an accurate and efficient system.
4. Projects a health leadership style that is participatory in nature.
5. Leads, directs and/or educates physicians, their offices, and clinics in the practice of case management and outcomes management.
6. Submits frequent updates to the Chief Nursing Officer (s) on issues that affect the department.
7. Directs the selection and interviewing of applicants for positions in the Case Management Department and participates in the termination of employees within the department.
8. Prepares formal performance evaluations of all case management staff.
9. Provides and documents in-service education to departmental staff.
10. Participates in continuous quality improvement initiatives including ensuring the referral of appropriate
cases to the Quality Improvement Department. Monitors variance from existing clinical pathways and/or protocols.
11. Identifies and participates in initiatives to address system issues which negatively impact lengths of stay, quality of care and/or inappropriate use of resources.
12. Directs studies of problem areas to improve utilization of health care services.
13. Facilitates the growth and ongoing development of the Case Management program based on leading industry practices, and benchmarking for leading clinical practices.
14. Responsible for the development, monitoring, analysis and trending of statistical and narrative data to analyze clinical, financial and quality indicators and outcomes.
15. Coordinates with multidisciplinary and performance improvement teams to collaborate on process improvement and implement service and system enhancements in a timely manner and in accordance with the hospital’s mission and departmental goals and objectives.
16. Does related work as assigned.
Current Maryland license in good standing as a Registered Nurse or an Independent Licenced Social Worker.
5-7 Years related experience
*UM CAPITAL REGION HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER. DECISIONS OF EMPLOYMENT ARE NOT BASED ON RACE, COLOR, RELIGION, GENDER, SEXUAL ORIENTATION, GENDER IDENTITY OR EXPRESSION, NATIONAL ORIGIN, AGE, GENETIC INFORMATION, DISABILITY, VETERAN STATUS, OR ANY OTHER PROTECTED STATUS.*