Director of Case Management/Swing Bed Coordinator

JOB SUMMARY AND SCOPE

Job Location will be at Calais Community Hospital and Down East Community Hospital

The Director of Case Management is accountable for the organization, sequence of services, and resources that are necessary and appropriate for the achievement of patient outcomes within effective time frames on a specific group of patients. The Director of Case Management must have ability to practice under minimal supervision and to perform the following six essentials of Case Management: Appropriateness of setting, Assessment, Planning, Implementation, Coordination, Monitoring and Evaluation with emphasis on decreasing length of stay and monitoring of cost effective health care across the continuum of care. This position is required to have competence to assess and case manages the age groups as indicated. The Director of Case Management evaluates patients for appropriateness, medical necessity, intensity of service, severity of illness, and performs continued stay reviews according to Interqual Acute Care Criteria. The Director of Case Management must meet resource management expectations, assist to reduce practice variations, and enhance patient outcomes. In addition the Director of Case Management serves as the Swing Bed Coordinator.

ESSENTIAL JOB FUNCTIONS

• Coordinate the care and services of selected patient populations across the continuum of illness
• Promotes effective utilization through reviews of Medicare, Medicaid, self-pay, and commercial insures admissions
• Provide a leadership role with the interdisciplinary team to achieve optimal outcomes
• Ensure timely discharges through early assessment and development of a discharge plan with early identification of barriers to discharge
• Communication with physicians, staff, patient/family, outside agencies to provide continuum of care
• Responsible for maintaining the Case Management Policy and Procedure Manual with annual review and updates as needed
• Responsible for writing policies and procedures for the Case Management Department
• Performs continued stay reviews using InterQual Criteria
• Verifies that all inappropriate admissions, unnecessary continued days, and procedures not meeting approved indications are forwarded to physician advisor
• Issues notices of non-coverage to patients and families as required within Medicare and Medicaid guidelines
• Conducts formal and informational staff education to all disciplines related to case management
• Identifies opportunities for intradepartmental and interdepartmental operational improvements
• Responsible for quarterly case management meetings to include formulating agenda and conducting the meeting
• Adheres to the organizational leadership profile
• Reliable attendance and punctuality
• Performs duties in a safe manner, in compliance with all safety policies and procedures
• Complies with the Code of Conduct and all appropriate policies and procedures
• Other duties, as assigned, that are relevant to the position and department