POSITION SUMMARY

Under the supervision of the Director assumes responsibility in managing the human and material resources of the Case Management Department in order to provide quality patient care and an environment conducive to staff growth and professional performance. This individual remains clinically competent in area of practice. Interprets and enforces policies and procedures, standards of care and standards of practice with others and demonstrates same through own actions.  This individual remains clinically competent in the area of practice and is able to take a direct patient assignment as needed.

LEADERSHIP VALUES

The MNH Leadership Values we are striving to emulate:

•       Respect, appreciation and caring for all-positive outlook

•       Initiative, achievement oriented, drive for excellence and continuous improvement; perseverance and ability to see the big picture

•       Teamwork and support for others; interdependence and commitment to the collective; system success as opposed to individual achievement or credit

•       Open, respectful, candid communication; handles conflicts and differing points of view directly; doesn’t shy away from difficult issues or conversations

•       Stewardship of resources and passion for efficiency

•       Ownership of actions and results focused

•       Resilient; adaptable to change; perseveres in the midst of challenges

•       Courage

MINIMUM REQUIREMENTS

Education:

1. Bachelor of Science Degree in Nursing, Social Work or related Health field  required.
2. Master’s Degree preferred

Experience:

1. Five years of Case Management experience required.

2. 1 year supervisory experience required.

Knowledge, Skills, Abilities:

1. Demonstrated leadership and interpersonal skills.
2. Ability to work effectively under stressful situations.
3. Demonstrated oral and written communication skills.
4. Ability to function in an independent manner with little or no need for direct supervision.
5. Effectively communicates verbally with patients, physicians, visitors, co-workers and supervisors.
6. Ability to document data and other information.
7. Ability to read and interpret written communication.
8. Ability to speak, read, and writes the English language.
9. Conducts business in a professional and cordial manner that upholds the integrity and reputation of Mount Nittany Medical Center.
10. Knowledge of human resource laws and regulations as they relate to the management of staff.

License/Certification/Registration:

1. Current licensure as a professional registered nurse in the Commonwealth of Pennsylvania or LMSW/LCSW (Social Work) license preferred.
2. Certified Case Manager (CCM) preferred.
3. Meets the American Heart Association’s standards for Healthcare Provider Basic Life Support (BLS) and renews BLS every two years.

SUPERVISION RECEIVED

Works independently to achieve departmental goals and objectives consulting with the Director as needed and/or in accordance with established policy.

SUPERVISION GIVEN

Supervises assigned staff in the Case Management Department.

ESSENTIAL FUNCTIONS

Manages assigned unit personnel. Provides day-to-day supervision of case management activities.

1. Strategic Oversight: Develops and implements case management programs, including utilization review, intake, and discharge planning.
2. Coordinates and collaborates with staff to plan unit/ patient assignments according to staff education, training and ability, standards of care and patient needs.
3. Actively participates in recruiting, interviewing and selecting unit staff. Participates in and/or conducts performance reviews, as well as counseling and discipline of unit staff.
4. Ensures staff meet the minimum qualifications of their positions at all times including licensure, certification and registration.
5. Plans and evaluates work flow for continuity of patient services which assures collaboration with health care team; enhances cost management.
6. Actively participates in Inter Rater Reliability monitoring of staff.  Performs document review of data entry for completeness, accuracy, and clarity of documentation submitted by case managers per record audit policy and procedures.  Seeks corrections, completion and /or clarification from case managers and data entry when necessary, providing education/ instruction and reinforcement of policy and procedures.
7. Monitors case management activities and time-line compliance through monitoring of case management reports and logs
8. Coordinates the orientation process for new employees.
9. Monitors observation, admission, and length of stay data on a monthly basis.
10. Resource Management: Monitors departmental budgets, expenses, and the use of medical resources to enhance cost-effectiveness
11. Regulatory Compliance: Ensures all practices meet federal, state, and organizational guidelines, such as Medicare/Medicaid/ Commercial  requirements and JCAHO standards

Facilitates communication regarding patient care.

1. Acts as a liaison with the medical staff to coordinate medical and nursing management of patient care.
2. Serves as resource for conflict resolution when patient issues are unresolved by primary care givers.
3. Presents changes and innovations in a positive manner.

Manages patient care/ Assuring Quality Discharge Planning

1. Performance Monitoring: Analyzes patient care data and key care indicators to identify trends, reduce delays, and improve clinical outcomes.
2. Assures that patients have received assessment and reassessment of physical care, psychosocial support and education to be discharged safely.
3. Assures collaboration with appropriate other health care providers resulting in formulation of a nursing diagnosis and initiation/revision of a care plan consistent with the medical plan of care.
4. Actively participates in utilization management of patients across the continuum of care.
5. Monitors readmissions.
6. Monitors participation in Daily Discharge Rounding’s for each unit.
7. Coordinates interactions with other health care facilities, community agencies and the public as appropriate with regard to assigned areas of responsibility and operations.

Denial Management

1. Utilizes Best Practice strategies for Denial Management.
2. Assumes the primary responsibility of denial management Axis program.
3. Manages in coordination with Director the appeals management process.
4. Serves as liaison with the finance/ billing department for claims issues.
5. Monitors concurrent and retrospective denials.
6. Builds and maintains effective relationships with the payers.
7. Works collaboratively with the Physician Advisor.
8. Participates in the UR Committee – reporting monthly denial management activity as requested.

Manages personal professional growth and development as well as the unit’s staff.

1. Demonstrates the qualities of advocate, role model, mentor and facilitator during growth and development of self, nursing staff and other health care team members.
2. Delegates appropriately and provides unity of command; assists staff with delegated responsibilities.
3. Provides leadership, direction and remediation to unit specific nursing personnel in accordance with organizational, departmental and governing agency goals, objectives and standards.
4. Team Leadership: Manages, mentors, and evaluates a team of case managers and social workers to ensure high-quality care.

NON-ESSENTIAL FUNCTIONS

Performs related and miscellaneous duties as assigned.