Description
ABOUT SHERIDAN MEMORIAL HOSPITAL
At Sheridan Memorial Hospital, we are proud to have achieved the 5-Star Quality Rating, ranking us in the top 13.6% of hospitals rated by the Centers for Medicare and Medicaid Services. We believe that our ability to deliver excellent healthcare begins with our people, and we are proud of our more than 750 skilled, experienced, and caring employees. We have over 100 providers who specialize in 25 areas of expertise. Our facility is state-of-the-art, and we are dedicated to providing outstanding patient-centered care. · Nestled at the foothills of the Big Horn Mountains in northern Wyoming, spectacular scenery and outdoor activities abound. Our hospital has the latest technology and equipment comparative to that of many larger facilities, and you will find our staff is friendly, compassionate, caring, and courteous. We focus on creating and nurturing a workplace that encourages, recognizes, and rewards individual effort and creativity. Leadership is responsive to changing modes of healthcare delivery and adapts accordingly. We value effective communication and honesty and believe teamwork based on mutual respect is key to success.
JOB SUMMARY
Responsible for the management and overall activities and functions of the Case Management and Utilization Review department. Department services include Care Coordination, Discharge Planning, Utilization Review, Denials Management and Case Management. Provides support/replacement when the Care Coordinator, Utilization Review Nurse or the Discharge planner are not available or are overtaxed and require assistance. Produces and manages agreed upon metrics and reports for distribution to other stakeholders per policy and procedure. Provides operational leadership to the Utilization Review Committee. Provides operational leadership of regulatory requirements for discharge planning, readmission reduction and reporting for quality metrics. Updates the Utilization Review plan for the organization as required.
ESSENTIAL JOB FUNCTIONS
Oversight of EHR (Executive Health Resources) referrals and usage.
Responsibility for the following functions:
Utilization Review
Care Coordination
Discharge Planning
Denials Management
Access Case Management
Management of qualifications, competencies, staffing levels, workload and productivity, regulatory compliance, continuing education, performance evaluations, and onboarding process within the department
Builds program collaboration with physician in areas of discharge planning and utilization review to allow continuous improvement in practices and ongoing education with medical necessity standards.
Maintenance of systems, processes and education to improve customer satisfaction and SMH outcomes
Expertise in application of CMS Conditions of Participations and other regulations and standards for the Joint Commission and consistently updates the Department accordingly
Review Medical Management data for trends and opportunities for improvement
Review current processes regularly to ensure maximum efficiency and effectiveness, including but are not limited to:
Length of stay
Long-stay patients
Readmissions
Denials
Medicare Beneficiary Notice Compliance
Condition Code 44 compliance
Patient choice compliance
Avoidable day compliance
Shows initiative by suggesting improvements using innovative and creative problem-solving abilities.
Provides coaching and mentoring to others to achieve department goals.
Re-evaluates department data and assesses the success of department plans, constantly makes suggestions and revises the department's goals and plans as necessary to adjust to changing healthcare rules and regulations.
Displays role-modeling behavior.
Exhibits clear, open and honest communication with others.
Establishes and maintains effective relationships with department heads, nursing managers and administrators and administrative staff
Oversee the development and compliance with departmental policies and procedures.
Review all readmissions per conditions of participation, collaborating with physicians as appropriate in the review.
Actively participates in the UM Committee, leading the presentation of data and metrics including but not limited to:
Utilization
Readmissions
Quality
LOS
Opportunities for improvement.
Outlier case review per the utilization management plan.
Collaboration in the development of the utilization management annual plan.
Analyzes and presents departmental metrics explaining all variances and presenting opportunities for improvement.
Provides data for quality council and other requests to measure ongoing performance in meeting departmental and organizational metrics.
Leadership and Human Resource Management
Demonstrates consistent leadership performance and behavior by actively being engaged in making SMH/BHHN a five-star provider of quality care by being a positive force within the organization and actively promoting teamwork and harmony. Delegates effectively and supervise follow-through. Persuasive, fair, impartial, sets high standards, and ensures clear focus and direction. Achieves desired results with support, confidence and integrity. Regularly recognizes the achievements of others. Leads others to success, supporting individual and team accomplishments.
Supervisory duties and responsibilities include:
Writes and conducts annual performance appraisals and ensures regular ongoing feedback, coaching, and communication with staff.
Ensures a high level of performance standards and achievement to meet organizational needs and business goals.
Provides development opportunities for staff to broaden and enhance their skills and abilities.
Administers organizational policies and procedures.
Ensures compliance with safety policies and good housekeeping.
Manages initial training of new employees and ongoing training as required.
Promotes an environment that fosters team work and commitment to satisfying customer requirements.
Ensures appropriate coverage of all areas of responsibility, to include covering responsibilities as needed.
POSITION QUALIFICATIONS Education / Experience / License and Certifications
Related degree in appropriate professional areas, including but not limited to:
Nursing: Bachelor's Degree in Nursing required; Master's Degree preferred.
Social Work: Masters in Social Work required
Minimum of 3 years supervisory experience, preferred.
Minimum 3-5 years of hospital Case Management/discharge planning and/or utilization managem
Compensation Information:
$0.0 / - $0.0 /
Starting At: 0.0
Up To: 0.0
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