Director of Case Management and Social Services

Case Management / Social Services Manager

Responsible for the overall administration and direction of the Case Management / Social Services Department, including planning, organizing, controlling, and directing all services and operations in the areas of Utilization Review and Discharge Planning. With primary focus of this role being on patient throughput, length of stay and denials.

This position requires providing managerial / administrative supervision to departments which provide services to critically ill through rehabilitating neonatal through geriatric patient population in a manner that demonstrates an understanding of the functional and / or developmental age of the individual served.

This position requires the full understanding and active participation in fulfilling the Mission of San Gabriel Valley Medical Center. It is expected that the employee will demonstrate behavior consistent with the Core Values. The employee shall support San Gabriel Valley Medical Center's strategic plan and the goals and direction of the Performance Improvement Plan (PIP).

Responsibilities

Responsible for 24 hour departmental coverage regarding Case Management and Social Services.

Serves as a resource person & internal consultant to department heads, medical staff & hospital staff, relating to Case Management.

Initiates problem investigations in response to concerns received for investigation & action by appropriate manager.

Responsible for ongoing education to hospital staff on Case Management.

Responsible for positive staff morale, staff absenteeism management and low turnover. Ensures qualified new hires and vacancies levels are appropriate.

Reviews all Quality Assurance referrals from Case Managers and refers cases for peer review.

Accountable for the selection, performance & retention of qualified staff to carry out quality care systems in accordance with defined needs & organization objectives.

Responsible for the budget development & implementation of the Case Management department.

Responsible for close interaction with Administration & physicians to manage costs & quality of care.

Coordinates the design, development & evolution of systems to monitor & evaluate the achievement of optimal clinical outcomes.

Contributes to Nursing Services & institutional operations through active participation on committees & programs.

Guides practice groups in the team development of critical paths to yield patient specific & aggregate data related to patient outcome.

Coordinates creative interventions directed at reducing acute Medicare and MediCal length of stay to established targets.

Facilitates reduction in MediCare Delay of Service and End of Stay denials.

Facilitates reduction in out-of-network days by capitated patients.

Assures Medicare Milliman Clinical Guideline (MCG) are used to document and communicate Intensity of Service and Severity of Illness.

Coordinates and communicates Avoidable Patient Day trending / profiling.

Participates in hospital / medical group Joint Operating Committee meetings.

Performs the duties and responsibilities of Denials Case Mgr RN.

All other duties as assigned.

Qualifications

Bachelors of Science in Nursing required

Masters degree in nursing preferred

Graduate of a RN School of Nursing

CA License required

Broad knowledge of medical and allied health sciences

Extensive knowledge of Joint Commission, state and federal regulatory requirements

Results oriented with proven case management experience

Excellent written and verbal communication skills.

Current CA RN License

Current AHA BCLS Certification

Case Management Certification (to be completed within 6 mos upon hire)