Director of Case Management

Overview

UT Health East Texas is comprised of 9 hospitals, more than 90 clinics, nearly 7,000 employees and over 1,000 licensed inpatient beds. We provide healthcare services through our hospitals, clinics, Level 1 trauma facility, air emergency fleet and EMS service.

POSITION SUMMARY

The Director Case Management has overall responsibility for hospital case management, social work, transition management and operational management of the case management department to promote effective utilization of hospital resources, collaboration with healthcare partners for timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and compliance with all state and federal regulations related to case management services.

Responsibilities

Formulate and implement operational strategies and initiatives to meet hospital and Ardent critical indicators including length of stay.

Oversight of the facility’s Case Management team to ensure compliance with standards of practice and other regulatory requirements related to care management and social work.

Develop and foster effective collaboration between Case Management Departments, Medical Staff, corporate case management and facility leaders to ensure an integrated approach to providing care while fulfilling the hospital's goals and objectives.

Display an ability to work effectively within the health system's decision making and organizational structures.

Work closely with providers as well as internal and external physician advisors for utilization review and management activities.

Coordinate all UM Committee activities to ensure compliance with meeting frequency and documentation of activity and outcomes.

Work collaboratively with Revenue Cycle teams and participates in task force meetings related to medical necessity audits and denials.

Participate in appeals processes and work collaboratively with vendors to ensure the effectiveness and timeliness of appeals.

Analyze length of stay and readmissions data and incorporate measures with Operations team members, Corporate Case Management, and other facility leaders to ensure goals are met.

Introduce evidenced based practices geared to improve case management and transitions.

Conduct regular staff meetings to review pertinent Federal and State regulatory requirements, emerging internal and external trends, and provide general training for staff

Qualifications

Education & Experience

• RN, Associates degree in nursing or higher. Social Work degree, BSW or higher.
• 3+ years’ experience in a case management leadership role.
• 2+ years’ experience in acute hospital-based case management, preferred.
• Certification in case management (ACM or CCM), preferred.

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