Director, Case Management
Apply NowCompany: KPC Health Care, Inc.
Location: Hemet, CA 92544
Description:
DEFINITION
Directs Case Management and Social Services personnel to ensure appropriate utilization of hospital resources, reimbursement for services and achievement of positive patient outcomes. Collaborates actively with the Medical Staff, Department Directors, Payors and outside organizations to appropriately manage the care of patients in a high-quality, cost-effective manner.
POSITION QUALIFICATIONS
A combination of appropriate education and experience that results in the required knowledge and abilities.
Education
Bachelor's of science in nursing from an accredited college or university preferred.
MBA or MHA preferred.
Experience
Five (5) years of experience in nursing. At least 3 years of which are in acute care case management.
Licensure/certification
Possession of current California Registered Nurse License or licensed in a state that has reciprocity with California.
KNOWLEDGE & ABILITIES
Knowledge of:
The application of InterQual guidelines.
Payor documentation requirements and governmental regulations affecting reimbursement.
Hospital nursing principles, methods, and commonly used medical procedures.
Common patient disease processes, and the usual methods for treating them.
Identification of potential discharge needs.
Typical hospital and skilled nursing facility organization and operations, as well as, the interrelationship of various clinical and diagnostic services.
Ability to:
Provide guidance and assistance to case managers and social services personnel:
Making recommendations regarding continued stay necessity, appropriateness of the level of the delivery of care.
Identifying discharge needs. Assess available resources and formulate appropriate discharge plan.
Communicating documentation needs in a manner that promotes cooperation.
Gathering and analyzing data and prepare reports and recommendations.
Working effectively with physicians, other health providers, outside payor sources, community resources, and the general public.
Relating positively with patients and families; demonstrate crisis intervention skills.
Collaborating with other nursing personnel, physicians and health care professionals regarding the plan of care.
Assessing patient/family needs for post discharge care. Plans and implements quality, efficient discharge plan, enabling patient to function at their highest level of independence.
Create quantitative reports for PIC and other key Corporate meetings.
Ensure weekly interdisciplinary case management rounds.
Communicate with Corporate leadership on status of initiatives.
Directs Case Management and Social Services personnel to ensure appropriate utilization of hospital resources, reimbursement for services and achievement of positive patient outcomes. Collaborates actively with the Medical Staff, Department Directors, Payors and outside organizations to appropriately manage the care of patients in a high-quality, cost-effective manner.
POSITION QUALIFICATIONS
A combination of appropriate education and experience that results in the required knowledge and abilities.
Education
Bachelor's of science in nursing from an accredited college or university preferred.
MBA or MHA preferred.
Experience
Five (5) years of experience in nursing. At least 3 years of which are in acute care case management.
Licensure/certification
Possession of current California Registered Nurse License or licensed in a state that has reciprocity with California.
KNOWLEDGE & ABILITIES
Knowledge of:
The application of InterQual guidelines.
Payor documentation requirements and governmental regulations affecting reimbursement.
Hospital nursing principles, methods, and commonly used medical procedures.
Common patient disease processes, and the usual methods for treating them.
Identification of potential discharge needs.
Typical hospital and skilled nursing facility organization and operations, as well as, the interrelationship of various clinical and diagnostic services.
Ability to:
Provide guidance and assistance to case managers and social services personnel:
Making recommendations regarding continued stay necessity, appropriateness of the level of the delivery of care.
Identifying discharge needs. Assess available resources and formulate appropriate discharge plan.
Communicating documentation needs in a manner that promotes cooperation.
Gathering and analyzing data and prepare reports and recommendations.
Working effectively with physicians, other health providers, outside payor sources, community resources, and the general public.
Relating positively with patients and families; demonstrate crisis intervention skills.
Collaborating with other nursing personnel, physicians and health care professionals regarding the plan of care.
Assessing patient/family needs for post discharge care. Plans and implements quality, efficient discharge plan, enabling patient to function at their highest level of independence.
Create quantitative reports for PIC and other key Corporate meetings.
Ensure weekly interdisciplinary case management rounds.
Communicate with Corporate leadership on status of initiatives.