GENERAL DUTIES:The individual in this position has overall responsibility for operational management of the Case Management Department, Social Services and Bed Control; including staffing, budgets and plans. The individual’s responsibilities will include, but not be limited to the following activities:a) Complying with relevant Tenet policies including Case Management and Clinical Determination Policies b) implementing and revising the UM Plan and promoting cooperation with utilization review standards by the medical staff c) Maintaining / facilitating communication between the case management department and the physician advisor on a regular basis regarding utilization review and/or quality issues d) Maintaining / facilitating communication between the case management department and the physicians as well as other members of the healthcare team e) analysis of reports: LOS, avoidable days, disputes, InterQual and associated metrics f) Responsible for implementation and compliance with all policies and regulations relating to the functioning of the case management department g) and all other duties as assignedAttends a workshop webinar led by PMI Case Management leadership or designee that includes the Tenet Case Management Model and other topics specific to role and responsibilities.Information used to perform job: patient data, healthcare staff documentation related to patient care, regulatory and payor requirements, budgetary and operations dataSoftware used to perform job: eCCM: Clinical data interface, InterQual, Case Management documentation, secure faxing, Avoidable Day tracking, Patient Medical Record and HPF, hospital specific Clinical Software, Enterprise Reporting: Decision Support reports, PMI reports, Care Discovery, Position ControlDEPARTMENT SPECIFIC DUTIES: Priority 1. Oversee coordination of clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post- acute care) compared to evidence-based practice, internal and external requirements. (40% daily, essential),Priority 2. Oversee department operations (staffing, scheduling, education, budget etc). (20% daily, essential).Priority 3. Perform data gathering, analysis and reporting. (20% daily essential).Priority 4. Remain current with relevant clinical/ case management practices. Attend and participate in meetings related to Quality, Operational and Financial improvement (20% daily, essential).All staff assigned to department (case managers, social workers, case manager assistants, administrative assistants). Other responsibilities as assigned e.g. disaster preparednessThe metrics below provide an indication of the effectiveness of the individual in this role and may be used for evaluative purposes. The list below is not meant to be exhaustive; other relevant metrics may exist.• Compliance with Tenet Case Management policies• Obtaining valid physician order prior to bed placement• InterQual reviews • Observation hours• Excess Days/ALOS• Clinical disputes - incidence and dollars• Number and type of avoidable days • Resource Utilization• At least 5 hours of CEUs per year on topics related to Case Management.
Required:Registered Nurse with a BSN and an RN License Extensive management and clinical experienceExperience in improving organizational performanceExperience in facilitating and leading multidisciplinary teamsStrong written and verbal communication skillsDemonstrated ability to organize and work with groups of peopleAbility to present data to professional groups and institute changes based on the data presentedDemonstrates effective problem solving and decision-making skillsMinimum of 3 years of experience as a case managerDirectors hired prior to August 2009 are grandfathered in with the same performance expectations. Preferred:Registered Nurse with a BSN and a California RN License Job: Case Management/Home HealthPrimary Location: Palm Springs, CaliforniaHospital Location: Desert Regional Medical CenterJob Type: Full-timeShift Type: 8 Hour Day Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status.
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