Job Information
Hackensack Meridian Health Director, Case Management in Neptune, New Jersey
Overview
Our team members are the heart of what makes us better.
At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.
Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.
The Director, Case Management is responsible for planning, organizing and directing all activities related to Case Management, Social Work and Utilization Management, including, but not limited to discharge planning, medical necessity, regulatory compliance and denial prevention. Ensure transition management promotes appropriate length of stay, readmission prevention, and patient satisfaction. Provide Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care; and education provided to physicians, staff, patients, families and caregivers. Promotes and supports collaboration with all appropriate departments to meet identified goals.
This on-site position will support Jersey Shore University Medical Center located in Neptune, NJ.
Responsibilities
A day in the life of a Director, Case Management at Hackensack Meridian Health includes:
Serves as a key participant in the design, implementation and monitoring of the case management program.
Leads the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement.
Develops and manages the annual budget for all departments that directly report including: monitors expenses, modifies operational expenditures, equipment, staffing, and submits monthly documents variances reports.
Trends data and presents areas of opportunities to network leadership to improve current practice.
Leads and monitors metrics for identified network pilots
Establishes and maintains a collaborative relationship with physicians, medical directors, nurses and other unit staff, and payers. Collaborates with physicians to understand medical practice issues.
Participates in the development of department policies and procedures and process improvements.
Has oversight of the physician advisors. Reviews their performance metrics with the PA's and CMO.
Creates action plans to improve PA performance as needed.
Seeks assistance of physician advisors, appropriate Chair and/or Vice Chair to assure compliance with correct patient status, timely discharges/transfers in accordance with length of stay criteria.
Manages department operations to assure effective throughput and reimbursement for services provided.
Remains knowledgeable of, State and Federal requirements regarding discharge planning/social work and utilizationmanagement; including Medicare, Medicaid and Managed Care regulations. Demonstrates the ability to adapt to change; thereby, effectively responding to changing needs, conditions or priorities.
Directs day to day operations ensuring compliance with regulatory requirements. Monitors and implements legal compliance measures.
Ensure medical necessity review processes are completed accurately and in compliance with CMS regulations.
Ensure timely and effective patient transition and planning to support efficient patient throughput.
Develops and implements an integrated process for the functions of Care Coordination, Utilization Review and Discharge Planning which includes working collaboratively with other disciplines.
Implements and monitors processes to prevent payer disputes.
Tracks and trends data to identify areas for denial prevention.
Develop and provide physician education and feedback on hospital utilization.
Ensure compliance with state and federal regulations and Joint Commission accreditation standards.
Refers cases identified as risk management issuers, peer review issues, or quality issues to the appropriate personnel.
Develops and establishes effective systems that ensures the required functions are performed; Medical Necessity reviews; including reviews of the appropriateness of admissions (observation versus inpatient admission status) and length of stays.
Monitors patient and family satisfaction through system approved measures, participates in the development and monitoring of any departmental quality initiatives.
Works with department supervisors to determine and monitor workload productivity standards for staff.
Identifies trends and performance improvements. Coordinates training based on identified needs.
Has the authority to evaluate, hire, counsel (using established disciplinary processes) and terminate staff in accordance with Human Resource policies.
Evaluates performance of staff and completes performance appraisals.
Keeps abreast of changes of regulatory and professional standards and communicates these standards as needed to leadership and team.
Adheres to the standards identified in the medical center's organizational and managerial competencies.
Escalates identified trends and issues to network leadership in a timely manner.
Ensures that CM staff provides clinical information to the appropriate payer source as required or requested through approved HIPAA and confidential methods in a timely manner to facilitate financial coverage of the hospitalization and to avoid denials of coverage.
Exhibits clear communication skills with all internal and external customers. Provides excellent service routinely in interactions with all customers, coworkers, patients, visitors, physicians, volunteers, etc.
Qualifications
Education, Knowledge, Skills and Abilities Required:
Bachelor's degree in nursing or Master's degree in Social Work.
At least 5 years full time experience in an acute care setting.
Familiar with hospital resources, community resources, and/or resource/utilization management.
Care coordination, case management, discharge planning and/or utilization review experience.
Effective decision-making /problem-solving skills, demonstration of creativity in problem-solving, and influential leadership skills.
Excellent verbal, written and presentation skills.
Moderate to expert computer skills.
Education, Knowledge, Skills and Abilities Preferred:
Master's degree in nursing, Social work or related field.
Minimum of 2 years of experience in case management Leadership.
3-5 years previous experience in Case Management.
Extensive knowledge of Xsolis and EPIC.
Working knowledge of the financial aspects of third-party payers and reimbursement.
Licenses and Certifications Required:
NJ State Professional Registered Nurse License or NJ Licensed Clinical Social Worker or NJ Licensed Social Worker.
Accredited Case Manager Certification and Certified Case Manager.
If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!
Job ID 2024-148305
Department Corp Care Management
Site HMH Hospitals Corporation
Job Location US-NJ-Neptune
Position Type Full Time with Benefits
Standard Hours Per Week 40
Shift Day
Shift Hours Day
Weekend Work Weekends as Needed
On Call Work On-Call Commitment Required
Holiday Work As Needed