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Form of workJob Description
St. Luke’s Hospital has an opportunity for an experienced Director of our Case Management Department! Our hospital is one of very few critical care hospitals in the country that earned 5-Stars in patient satisfaction from CMS in 2020 and we need YOU to help us get to the next level! In this role, you will be part of a progressive team dedicated to advancing the goals of the hospital, meeting the needs of our rural community, and providing outstanding care to our patients. At St. Luke’s, we ALL make a difference!
Essential Functions include but not limited to:
Essential Functions include but not limited to:
- Recruits, hires, trains, evaluates, counsels personnel performing case management activities.
- Develops and implements policies and procedures to support the case management processes as outlined in the Utilization Management Program written plan.
- Reviews case management activities for occurrences and trends that affect the quality, cost effectiveness and delivery of patient care services; appropriately documents the review; consults with other departments and administration to reach resolution of identified problem areas and institute changes as needed.
- Acts as liaison with area nursing homes and other healthcare facilities to promote the services of the hospital, including outpatient diagnostics, and swing beds. Facilitates the admission process for swing bed transfers from other facilities.
- Demonstrates strong working knowledge of current regulations and standards of the Joint Commission, CMS, the State of NC, and managed care plans as it relates to level of care determination, medical necessity and length of stay criteria for all payers.
- Maintains oversight responsibility for the review of all physician/provider usage patterns for medical necessity and appropriateness of care against screening criteria.
- Coordinates the discharge planning function in conjunction with the discharge planner/social worker.
- Acts as Facility Compliance Advisor for the Compliance Program and ensures timely completion of the quarterly Compliance Work Plan. Holds department teammates accountable to comply with the Compliance and Privacy Programs of the facility.
- Organizes and facilitates Utilization/Case Management Committee meetings as required by the UM Plan.
- Maintains patient confidentiality at all times in compliance with the HIPAA Privacy Rule.
Required knowledge, skills, and abilities:
- RN license in North Carolina or bachelor’s degree in social work required.
- Certification in Case Management required
- Two or more year's acute hospital, home health, hospice, inpatient mental health facility experience preferred.
- Ability to effectively communicate in English, both verbally and writing.
- Strong written and verbal skills.
- Comfortable with Microsoft Office products, including Word, Excel, Outlook and ability to function as needed within the facility's electronic medical record system.
- Current knowledge of Critical Access Hospital requirements, coding, Medicare Criteria for levels of care, and the process for issuing letters of non-coverage.
- Understanding of healthcare/HMO industry, including Medicare and Medicaid Managed Care Plans.
- Knowledge of financial and/or statistical analysis
- Demonstrates the ability to be flexible, organized and function under stressful situations.
Additional Information
Position Type : Full Time
Shift : Day
