Director Of Case Management

Company: Avem Health Partners
Location: Oklahoma City
Posted on: January 23, 2023

Job Description:

*JOB PURPOSE: *The Director of Case Management is responsible for the development of staff and systems to effectively operate a comprehensive Case Management Program. Provides leadership and consultation to case managers, social workers and case management coordinators. Assesses needs and plans, communicates and designs services that are appropriate to the hospital mission and patient/family needs. Integrates and coordinates services using continuous quality improvement tools.*ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO: ** Researches and identifies relevant industry standards. Updates job knowledge by studying trends and developments in case management.* Collaborates with executive management, establishes benchmarks that are attainable but exceed industry standards.* Introduce solutions to minimize denials, accommodate higher patient volumes and strengthen overall quality metrics.* Enhances clinical and financial outcomes through performance improvement activities.* Assists facility Case Management departments in regulatory compliance.* Directs and evaluates all services provided, including care plan development, service level determination, and complaint management to achieve performance and quality control objectives.* Provides specialized expertise, ensures resource alignment with system-wide initiatives, and updates appropriate parties on initiatives, outcomes and issues.* Performs under minimal supervision with accountability for specific goals and objectives.* Identifies and resolves problems.* Demonstrates problem solving, leadership, conflict management and team building skills in order to ensure a productive work environment and achievement of goals.* Enhances department and organization reputation by accepting ownership for accomplishing new and different requests; explores opportunities to add value to job accomplishments.* Oversees internal audits to ensure consistency and compliance with organizational standards, clinical pathways, and external requirements.* Evaluates clinical documentation with regard to medical necessity, appropriate use of clinical pathways, evidence-based care, and efficiency of care.* Ensures compliance in all risk management matters for Company's various lines of business, including all state, federal, and regulatory body requirements.* Other duties as assigned within scope of practice.*BEHAVIORAL STANDARDS** The individual must support the mission, vision, and goals of Avem Health Partners and serve as a role model within the company.* Exhibit positive customer service behavior in every day work interactions.* Demonstrate a courteous and respectful attitude to internal workforce and external customers.* Communicate accurately and appropriately.* Handle difficult situations in a discreet and professional manner.* Hold self-accountable for professional practice.* Participate in performance improvement activities utilizing principles to support and improve departmental goals.* Demonstrate knowledge of unit goals and is active in committees and projects to achieve these goals.* Keep current with literature regarding changing practices, interventions and best practices.* Assume responsibility for seeking out educational and professional opportunities for personal learning needs and growth as well as meeting mandatory education requirements.* Act as a preceptor as requested.* Demonstrate excellent work attendance and actively participate in a variety of meetings and training sessions as required.* Adhere to the Avem Health Partners Code of Conduct and Standards of Behavior. Complies with established policies and procedures and all health and safety requirements.*EDUCATION/QUALIFICATIONS: ** Graduate of an accredited school of nursing, BSN preferred.* Current Oklahoma RN license, current BLS.* Five (5) years' experience required.* Two (2) years of leadership or management experience required.* Understanding of the unique needs associated with various age populations and the ability to provide age specific care and services.* Must possess the knowledge and skills necessary to effectively meet the needs of the patient/internal & external customer.* Knowledgeable about Medicare, Medicaid, and other third party payers.* Knowledgeable about local, state, federal and community resources and the scope of services they provide.* Direct experience with regulatory agencies and third party payers within the last two years.* Experience in discharge planning and a working knowledge of alternative delivery systems including home health, durable medical equipment, rehabilitation, extended care facility and skilled nursing facilities, their scope of services and their criteria for care.* Consistently demonstrates a professional, self-directed, mature, disciplined and tactful approach to position responsibilities.* Practices good guest relations with patients, visitors, physicians and staff, assists as needed.* Intermediate computer skills.*CERTIFICATION/LICENSURE: ** Current Oklahoma RN license* Current BLS (or obtained within 30 days of hire)* Certified Case Manager (CCM) preferred* Valid driver's license*PHYSICAL REQUIREMENTS: ** To perform this job successfully, an individual must be able to perform each essential job duties satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant to be considered.* This job requires visual abilities, auditory abilities, must be intact to perform duties.#INDHPJob Type: Full-timeBenefits:* 401(k)* 401(k) matching* Dental insurance* Disability insurance* Flexible spending account* Health insurance* Life insurance* Paid time off* Vision insuranceSchedule:* 8 hour shift* Monday to FridayAbility to commute/relocate:* Oklahoma City, OK 73134: Reliably commute or planning to relocate before starting work (Preferred)Education:* Bachelor's (Preferred)Experience:* Case management: 5 years (Required)* supervisory: 2 years (Required)License/Certification:* Driver's License (Preferred)* Oklahoma RN License (Preferred)* BLS Certification (Preferred)* Certified Case Manager (CCM) (Preferred)Work Location: One location

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