Position Title: Director, Care Management

Division: USA Health, University Hospital

Position Description

The Director of Care Management is responsible for the overall direction and performance of the department of Care Management with USA Health. The director is responsible for ensuring appropriate discharge planning occurs and that resources are utilized efficiently. This position is also responsible for managing care management staff, including performance evaluations as well as overall development and design of care management staffing plans. Candidates should have experience across the continuum of care, and should be experts in the field of case management.

Essential Job Functions

• Holds 24-hour accountability for the operation of the department of Care Management
• Utilizes all available resources to assure effective performance of the department
• Provides appropriate staffing levels and skill mix to support departmental functions
• Performs personnel functions for the department to include recruitment, hiring, disciplinary actions, evaluations, counseling and education and follows university and hospital policies related to personnel functions
• Documents all personnel actions appropriately
• Supports all personnel as valuable assets to the institution
• Develops an annual budget that meets the departmental needs within the framework of available resources
• Coordinates with other department heads for effective resource use, monitors budgetary expenses and revenues, identifies variances and adjusts spending accordingly
• Utilizes cost effective practices in performing all aspects of the job
• Evaluates and recommends space allocation and design for the needs of the department
• Develops, implements and updates policies and procedures in a collaborative and interdepartmental process according to JCAHO and hospital standards
• Prepares and reviews bids, systems of acquisition, distribution and use of supplies, materials and equipment
• Supports the mission of the University of South Alabama by translating and incorporating institutional mission, vision and values to staff and others
• Provides an environment that is supportive of medical, nursing and allied health students
• Performs all duties in a professional and timely manner
• Utilizes a computer and appropriate software to generate reports and correspondence both written and electronic
• Abides by and enforces all compliance requirements and policies and performs these responsibilities in an ethical manner consistent with the organization’s values
• Facilitates staff participation in in-services and educational offerings to learn new skills and for continued development
• Assures personnel are competent to carry out their essential functions and that competency skills are completed annually
• Monitors work performance of staff
• Completes staff evaluations in a timely manner according to policy
• Develops a plan of action for employees who are below satisfactory in their evaluation and completes re-evaluation in the appropriate time frame
• Participates in the strategic planning activities for the department and institution
• Develops a strategic plan for the department that supports the institution’s overall plan
• Translates the department or institution strategic plan to staff, ensuring support of the plan, and modifying the plan in response to changing internal and external factors
• Assumes accountability for current standards established by professions, regulatory and governmental agencies
• Determines, translates, and implements relevant standards and promotes department compliance
• Maintains standards of practice consistent with current research findings
• Adheres to current Infection Control and Safety Standards
• Facilitates cooperative and collaborative relationships among disciplines/departments to assure effective delivery of services to support quality patient care
• Encourages and participates in planning and program development to facilitate the effective delivery of services that support quality patient care
• Communicates and uses appropriate customer relation skills with physicians, patients, families and healthcare team in person and via telephone
• Responds to overhead pages and beeper in a timely manner
• Develops and maintains a performance improvement program for the department utilizing the ICARE methodology
• Performs those functions for which they are licensed
• Manages the Care Management/Social Worker programs promoting high quality, cost effective, compassionate team approach in all patient care matters
• Manages the utilization review process, providing guidance and information to the team members including the medical staff, administration and other members of the healthcare team as needed
• Communicates with 3rd party payers on specific utilization and discharge planning issues
• Ensures that discharge planning is initiated on admission to the hospital including but not limited to placement post hospital, equipment needs, and follow-up appointments
• Assures that Medicare, Medicaid and other insurance regulations and revisions arc communicated to care managers, social workers, administration, physicians and to any other healthcare team members that need to know
• Participates actively in ensuring that overall compliance with regulatory and accreditation agency standards of care are met
• Identifies potential risk management of quality-of-care issues and resolves them through intervention or referral to the attending physician, Ethics Committee, Risk Management or Legal Services as appropriate
• Provides documentation as requested of continued services and informs physician when patients in their services no longer meet this criteria
• Provides leadership in Utilization Review, Social Worker programs, and MIC/RAC Audits
• Demonstrates regular and prompt attendance
• Ability to work schedule as defined and additional hours as required
• Related duties as required