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Director, Case Management & Social Services

JOB SUMMARY:
The Director of Case Management will be responsible for the strategic development and overall operations of Case Management functions to drive clinical, fiscal and compliance outcomes.
Develop effective and efficient systems and processes for care / utilization management, discharge planning / transition management, and coordination of care.
Oversees the collection, analysis, and reporting of data related to care management processes, utilization management and length of stay.
Accountable for achieving established performance targets through actively engaging multiple disciplines, professional staff and departments.
Appropriately manages people, relationships and process to optimize results.
Engages internal and external stakeholders in care management processes; promotes interdisciplinary collaboration; fosters teamwork; and champions service excellence.
EXPERIENCE/QUALIFICATIONS:
Five (5) to ten (10) years of progressive experience in nursing leadership and case management required. Strong clinical background, experience in care coordination, discharge planning and overall case management experience required.
Possess knowledge of payer requirements and discharge planning regulations that support the effect development of departmental policies, procedures and standards.
Demonstrates ability to: Establish the goals, vision, and overall direction of a department; create and implement departmental standards, systems, staffing plan and processes; analyze issues and create an effective plan to address them; Critically and comprehensively evaluate the department's outcomes; Identify, collect and analyze data related to the internal and external environment as well as departmental functioning.
Demonstrates ability to communicate verbally and in writing to internal and external constituencies.
Exhibits ability to establish priorities, meet deadlines, and develop and manage the departments' productivity standard in the management of work assignments.
Exhibits ability to form positive, collaborative relationships with members of the medical staff, hospital staff and post-acute providers and payers.
Exhibits ability to problem solve in a proactive, creative manner, using sound judgment based on factual information and clinical knowledge.
Exhibits ability to effectively negotiate with internal and external service providers.
Possess knowledge of external requirements that impact the department, i.e., DNV and California Department of Public Health.
Demonstrates proficiency of Interqual to support the evaluation and decision process used to determine the appropriate level of care.
Demonstrates case management experience in a risk contracting environment strongly preferred.
Possess knowledge of reimbursement and payment methodologies of managed care and medical population.
Demonstrates knowledge of basic Microsoft computer skills.
EDUCATION:
Baccalaureate degree in Nursing required; Master's Degree in Nursing or related field preferred.
LICENSURES/CERTIFICATION:
Current licensure with the California Board of Registered Nursing
Must successfully complete and maintain LA City Fire Card certification at the time of hire or within the first 30 days of employment
DUTIES AND RESPONSIBILITIES (These are the essential job functions for this position. The essential functions of this job include, but may not be limited to those listed in this job description. Employees hired for this position must be able to perform the essential function of this job without imposing significant risk of substantial harm to the health or safety of themselves or others):
Establishes, implements and evaluates a strategic plan for the department that takes into account internal and external factors effectively communicates the plan throughout the organization.
Creates data priorities and report formats that display critical outcome factors.
Provides feedback to the department staff regarding Case Management improvement opportunities identified through data outcomes.
Actively participates at the Utilization Management Committee €“ collaborates in the selection of standing agenda items, provides reports related data to be reviewed and/or requested data.
Develops structures and processes to facilitate participation by physicians, pharmacists, nurses, Social Workers and other health professionals in multidisciplinary care planning, care delivery, and discharge planning.
Facilitates transition of patients/families across the continuum by establishing relationships with appropriate providers and community services.
Establishes policies, procedures, and protocols for case management and social services.
Insures that the Utilization Management Plan is current and compliant with CMS and other accreditation requirements.
Creates processes to anticipate and address specific situations within the department, including long stay patients, post-acute resource referral lists, denials, and termination of benefits.
Creates a system for initial and ongoing education and development of staff.
Provides timely and effective departmental and organizational communication with a minimum of one (1) department meeting per month.
Creates a system for initial and ongoing education and development of staff.
Develops and adheres to case management and social services departmental budgets.
The following job accountabilities are not unique to this particular job but are common to all jobs at VPH:
Complies with VPH policies and procedures on customer satisfaction and service excellence. Demonstrates professionalism and cultural sensitivity in coordinating activities and communicating with all customers, peers, and the community at large. Conducts self in a professional, respectful and courteous manner during all interactions. Works effectively and collaboratively with others toward common goals.
Communicates accurately, honestly, supportively and in a timely manner with department and interdepartmental team members. Demonstrates effective business writing and oral communication skills, handwriting is clear and legible.
Participates in operational aspects of the department, and maintains/participates in performance improvement activities within the department.
Participates in all departmental specific training, Environment of Care (injury/illness prevention, fire/life safety, hazardous materials, emergency preparedness, utilities management, medical equipment management, safety and security management), infection control (standard precautions, TB Exposure Control Plan, Bloodborne Pathogen Exposure Control Plan).
Demonstrates knowledge of and follows safety practices. Understands the importance of safety, including patient safety in the work place. Maintains a safe environment for self and others.
Actively participates in the Patient Safety Program, including event reporting. Identifies sentinel events/near misses and responds per defined organization processes. Participates in education activities and process implementation. Demonstrates advocacy for the patient/customer and appropriately acknowledges patients, customers and visitors.
The above statements reflect the essential functions considered necessary to describe the principle content of the job. They are not intended to be a complete statement of all work requirements or duties that may be inherent in the job.
WORK ENVIRONMENT:
Primarily an inside building/office environment, well lighted and ventilated, which may consist of multiple treatment and/or work sites.
Fast and continuous work pace with variable workload.
Frequent contact with staff and public under a variety of circumstances.Requires ability to communicate clearly (in English) verbally and in writing for effective communication with other staff members, physicians, vendors, community members, patients and patient families, employees and applicants of all socio-economic levels from a diverse cultural and ethnic population.
Subject to many interruptions from multiple calls and inquiries and potentially emotional situations involving accidents, injuries, illness and/or death.
Handles emergency/crisis situations in accordance with Hospital policy.
Answers phones or pages; may carry a beeper/pager.
Occasional travel may be required.
Potential risk of exposure to hazards from chemicals (toxic and non-toxic), flammable materials, gas or electrical or radiant energy or equipment with/without moving parts

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