Mgr., Case Management

.Primary Purpose

Plans, organizes, develops and monitors all activities of the Case Management Program, including hiring, orienting and conducting staff meetings, to assist in the coordination of all health and human resources, and empowering families and clients to access appropriate health care resources and individualize the delivery of services and program plans.

Minimum Specifications

Education

• Must have a Bachelor's degree in Nursing or have a Master's degree in Social Work.

Experience

• Must have eight (8) years of hospital or community based case management experience, preferably in assigned clinical area. Applicant must have one year of experience in a progressively responsible supervisory role.

Equivalent Education and/or Experience

Certification/Registration/Licensure

• Must have current healthcare provider BLS for Healthcare Providers certification from one of the following:

American Heart Association

American Red Cross

Military Training Network.

• RNs Only: Must have current, valid RN license or temporary RN license from the Texas Board of Nursing; or, valid Compact RN license.
• Social Workers Only: Must be licensed by the Texas State Board of Social Work Examiners.

Required Tests for Placement

• RNs Only - Applicants must pass (85% or above) Dosage Calculation Exam prior to hospital orientation. Current Parkland employees requesting reassignment to role must have current Dosage Calculation Exam on file.

Skills or Special Abilities

• Must be able to communicate and collaborate effectively with a diverse group of patients, families and healthcare staff.
• Must be able to demonstrate a working knowledge of specific patient populations, and be able to demonstrate knowledge of disease processes affecting this group.
• Must be able to demonstrate a working knowledge of PC operations and the ability to use word processing software in a Windows environment.
• Must be able to demonstrate a working knowledge of the laws and regulations governing Medicare, Medicaid and community-based funding sources.
• Must be self-directed and capable of priority setting and problem solving.
• Must be able to demonstrate effective supervisory skills and techniques.
• Must be able to demonstrate patient centered/patient valued behaviors.
• RNs Only - Provides care to assigned patient population in accordance with the current State of Texas Nurse Practice Act, established protocols, multidisciplinary plan of care, and clinical area specific standards.

Responsibilities

Oversees the management of specific patient populations across the continuum, focusing on high-risk, high-cost patients. Comprehensively plans for program management of targeted populations for all risk categories.

Serves as a resource to the multidisciplinary team for the management of complex patients. Serves as the primary information resource in one or more designated Case Management skill areas for payers, physicians, other healthcare team members, and other customers (skill areas include: regulatory requirements, pathway development/implementation, ethics/healthcare law, clinical skill, etc.). Coordinates, represents and/or acts as a liaison for healthcare team and major customers (e.g. Payers, Multi-specialty physician groups, etc.).

Responsible for oversight of patients transitioning through the healthcare system based on individual and patient population needs. Directs liaison activities to appropriately integrate the patient in the healthcare continuum including procuring services, health promotion and counseling, health education and screening, and community resource linkage.

Works with physician leadership and the multidisciplinary team for defined patient populations to develop and implement clinical practice guidelines, continuum care management programs, and measurement/feedback of performance indicators for cost, quality, service, and patient satisfaction. Leads multidisciplinary groups in designing and implementing innovative alternative solutions that address system problems and patient care issues occurring across the full continuum of care.

Responsible for oversight and management of all activities associated with utilization management, care facilitation, discharge planning and clinical documentation for assigned patient population.

Responsible for oversight of Case Management to monitor daily operational processes and communicates, as needed, with all areas regarding individual cases, processes and process improvements.

Oversees the effective delivery of services with the multidisciplinary team through patient care conferences and discharge planning activities. Collaborates and/or mentors members of the health care team regarding the plan of care, variance in plan implementation and outcome, and documents the findings in patient's record.

Participates in the collection and analysis of patient care data, fiscal data, clinical path variances analysis data, and outcome data relevant to the target case type in order to promote quality improvement. Responsible for program effectiveness and reporting requirements including Federal, State, and private grants for designated patient populations.

Works in collaboration with physicians and appropriate healthcare providers to identify and plan strategies to reduce length of stay, readmission rates, and resource consumption within the patient population.