DIR-CASE MANAGEMENT & UTILIZATION REVIEW

General Purpose of Job:

Directs and over sees operations and strategic planning for the department of Patient Support Services (Case Management) and Utilization Review/Management by translating the Hospital and Health System's vision and strategies into practice.Ensures quality, compassionate, cost-effective services are provided to patients served by the departments. Works in collaboration with the administrative staff, Directors, Managers, Physicians and Team Members to ensure coordination and integration of care and services.,

Essential Duties

• Participates in efforts to support and advance the Health System's mission, vision, strategies and goals.
• Provides leadership to Patient Support Services (PSS/Case Management), Utilization Review/Management (UR/UM), andstaff inclusive of designing work processes and assignments that optimize clinical and financial outcomes and patient and team member satisfaction.
• Identifies objectives and creates performance goals upon which to evaluate team member and department performance.
• Integrates innovative technology into Case Management processes to improve department effectiveness, team member satisfaction, and clinical outcomes for patients.
• Works in conjunction with the Medical Director of Utilization Management to lead the medical staff utilization management function. Represents PSSwith the Vice President of Finance, Administration, Medical Staff, Managers, other staff and external agencies. Provides information and advises the VP of Finance, and others as appropriate, regarding current and projected trends, areas of deficiency and significant activities related to the functions of PSS.
• Facilitates and fosters the development of a collaborative relationship between PSS, UM, nursing, Physician Advisors, other departments and the medical staff.
• Represents the Hospital and Health System to the community, educational institutions, professional organizations, payers and others.
• Ensures full compliance with regulatory and accrediting agencies and maintains awareness of changing requirements.
• Develops and implements short- and long-term goals for PSS and UR/UMthat reflect the Health System's strategic vision and goals.
• Selects, orients, mentors and evaluates Department Managers and supervisors.Makes recommendations on employee hires, transfers, promotions, salary changes, discipline, terminations, and similar actions. Resolves grievances and other personnel problems within position responsibilities.
• Maintains a high level of staff morale, professionalism, efficient and effective performance, motivation and pride in the services performed for patients and the Health System.
• In conjunction with Department Managers, develops the PSS and UR/UM annual financial plan. Manages activities to ensure adherence to department budget.Monitors the results and Key Performance Indicators (KPIs) and advises VP of Finance when there is a need to adjust the plan.
• Monitors customer satisfaction, performance improvement and corporate compliance indicators, integration of clinical guidelines, and key indicators of effectiveness and efficiency to ensure optimal performance.
• Participates in establishing policies and procedures, position descriptions, staffing needs and productivity

• Assists in the development and implementation of special projects.
• Supervises processes and personnel directly involved in securing financial authorization from payers for all inpatient and observation admissions and ensures operations are integrated with internal revenue cycle systems and third-party payer systems.
• Collaborates with personnel involved in the financial counseling of hospital inpatients, including the Hospital's Medicaid Eligibility vendor.