Manager Case Management at AdventHealth

Date Posted: 5/20/2020

Job Snapshot

  • Job Schedule
    Full-Time
  • Location:
    Mansfield, TX
  • Job Category
  • Date Posted:
    5/20/2020
  • Job ID:
    20010392
  • Job Family
    Case Management
  • Travel
    No
  • Shift
    1 - Day
  • Organization
    Texas Health Huguley Hospital

Job Description


Description

Case Management Manager -  Texas Health Mansfield- operated as joint venture between Texas Health Resources and AdventHealth


Location: 2300 Lone Star Road; Mansfield, TX


Top Reasons to Work at Texas Health Mansfield; Mansfield, TX 


•         Join a family of caregivers focused on whole-person health and committed to making communities healthier.


•         Provide wholistic care for patients that extends to the spiritual level by praying with patients and families.  Chaplains are available to meet with patients, families and team members 24 hours a day, 7 days a week to provide spiritual support.


•         Help develop a brand new $150 million community hospital and medical office building that will provide services such as Medical/Surgical, ICU, Women’s Services, General Surgery, Orthopedics, Interventional Cardiology and Gastroenterology.


•         Grow in your career with AdventHealth, named in 2018 by Becker’s Hospital Review as one of the “150 Top Places to Work in Healthcare”.  AdventHealth has partnered with Texas Health Resources, named in 2019 as one of Fortune’s 100 Best Companies to Work For, to build Texas Health Mansfield, which is creating new opportunities for employment and professional growth. 


•         Thrive in the Mansfield community, ranked by CNN/Money Magazine as #17 for “Best Places to Live”.  Mansfield is one of the fastest growing areas of North Texas, projected to reach more than 250,000 residents by 2023.  Future job growth over the next ten years is predicted to be 41%, higher than the national average of 33.5%.  Mansfield has top-rated schools, over 900 acres of parkland, quality housing, a historic downtown area, recreational opportunities for all ages, and a growing business community.

Work Hours/Shift:

Full Time

You Will Be Responsible For:

Service:

•         Patient satisfaction scores meet organizational goals for HCAHPS.

•         Strives to provide excellence in service to hospital staff, patients and families.

•         Consistently assumes authority for department activity.

•         Integrates the department services into the organization’s primary function.

•         Reviews current professional standards for each program and makes recommendations for changes in policy, procedures, equipment, and assignments.

•         Preparation of deliverables such as avoidable days, denial, and DRG options reports for the meetings as well as any other necessary reports.

People:

•         Manages the staff activities to ensure fulfillment of the institutional and program objectives.

•         Establishes and implements department goals and outcomes with involvement of staff in accordance with Patient Business Services goals and the hospital’s strategic planning goals.

•         Keeps staff informed of their responsibilities as well as activities and accomplishments of the hospital-wide programs.

•         Demonstrates care for one another and respect for each person’s unique contributions.

•         Serves as a clinical role model for staff. Maintains current skills & knowledge base in Case Management

•         Conducts regular scheduled and as needed staff meetings.

•         Prepares and administers performance evaluation for staff.

•         Interviews for positions and is responsible for hiring and terminating case management staff.

•         Works to improve retention of staff.

•         Ensures new staff receives complete orientation, as well as periodic review of progress toward independence.

•         Conducts 30 & 60-day new employee assessment, administers 90-day competency evaluation.

•         Appraises and counsels staff to improve performance through meaningful, timely feedback and performance review.

Finance

•         Consider factors related to patient safety, effectiveness, cost and impact on practice in the delivery of Case Management services.

•         Daily oversight of utilization review activities to ensure compliance with Medicare and Medicaid as well as contractual agreements with Managed Care contracts.

•         Ensures staff assign working DRG’s to establish geometric mean LOS, collaborate with CDIS staff to update working DRG as needed throughout the patients stay.

•         Aware of and educates the staff to remain vigilant in tracking avoidable days, educate how it influences and improves discharge planning practice.

•         Ensures concurrent denials addressed timely, keeps denial rate within benchmarks.

•         Ensures staff compliance with EHR physician advisor referrals for second level reviews.

•         Responsible to develop department budget. Monitors reports for variances and creates action plans as needed. 

•         Operates within designated budget to maintain expenditures within allocated funds, initiates actions to correct or seeks approval to maintain budget variances.

•         Utilizes InterQual®ISD & or Milliman criteria to ensure appropriate level of care settings.

•         Passes Annual Inter-Rater reliability testing for InterQual®.

•         Reviews monthly capitation reports.

•         Responsible for payer contracts reporting of issues, and overall management.

•         Maintains open dialogue with payers regarding utilization, case management, and discharge planning issues.

•         Maintains positive relationships and communication with other providers to ensure staff awareness of services available and to ensure patient needs are met.

•         Develops and maintains liaisons with local, state, and federal resources.

•         Uses a cost containment approach in management and reports cost containment measures.

Outcomes:

•         Develops and implements policies and procedures that guide and support the provision of case management services and social work services across the continuum of care.

•         Participates in Quality Improvement activities to improve processes and patient care.

•         Implements actions, as appropriate, recommended by Quality Improvement teams and the hospital wide Quality Management Council.

•         Provides Chief Nursing Officer with a comprehensive monthly report regarding department project status, accomplishments, and key issues.

•         Directs the design, development and preparation of necessary report. Prepares periodic reports for administration and committees.

•         Evaluates monthly reporting statistics and makes recommendations or changes as indicated.

Growth & Development:

•         Identifies and assists staff to maintain current information on community resources.

•         Maintains knowledge of current managed care contracts, federal statutes, regulations and procedures and applies them in performance of review activities.

 

•         Enhances professional knowledge and development through participation in educational programs, seminars, workshops and professional affiliations to keep abreast of latest trends in field of expertise. Demonstrates an ongoing commitment to learn.

 

•         Demonstrates the knowledge and skills required to lead teams in group’s projects and assignments.

 

•         Demonstrates evidence of continuous professional development. Identifies own learning needs and seeks opportunities for self-growth and career advancement. 

•         Attends annual mandatory in-service, required meetings and continuing education.


Qualifications

What will you need:

Individuals must possess these knowledge, skills and abilities and be able to demonstrate that s/he can perform the essential functions of the job, with or without reasonable accommodation, using some other combination of skills and abilities.

•         Application of InterQual® and or Milliman® Criteria set.

•         Assessment skills and knowledge application for all ages from newborn to geriatric.

•         Assessment of appropriate use of hospital services and care coordination.

•         Excellent oral and written communication skills.

•         Excellent computer skills for data analysis and reporting.

•         Ability to function independently and self-direct.

•         Experience with PC applications required (such as word processing, spreadsheets, and graphics).

•         Excellent interpersonal skills, oral and written communication skills required.

•         Graduate of an accredited School of Nursing.

•         Two years in Case Management or like experience

•         One-year experience at a supervisory/manager level.

•         Experience with PC applications required (such as word processing, spreadsheets, and graphics).

•         Excellent interpersonal skills, oral and written communication skills required.

•         Current Texas Registered Nurse license or licensure from another state with verification of application of eligibility for Texas licensure by endorsement.

•         BSN or other health related degree

•         MSN or health related degree preferred

•         ACM certification or CCM preferred

 

 

Job Summary:

The Manager of Case Management (CM) is responsible for the daily operations, long term planning and budget of the CM department in accordance with the Utilization Management Plan and department policy and procedures. The Manager is responsible for data management and reporting as mandated by Federal, State and Community regulatory agencies including QIO activities and Corporate required reporting. Personnel management and supervision of case management fosters cooperative working relationship with members of the Case Management team, physicians and patients to provide quality coordination and progression of care activities including: discharge planning & utilization review.  Plans, organizes, implements, and evaluates the activities of the Case Management Department, which include the functions of utilization management, discharge planning, social work services, and spiritual care as well the integration of these functions with fiscal services. Works closely with executive hospital leadership, physicians, nursing/clinical staff, and fiscal services to ensure that services provided by the department serve to optimize quality of patient care, utilization of hospital resources, and reimbursement by third party payers.

 

 



This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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