Director (RN), Case Management-7414-3166
Clinch Valley Medical Center
Under the general supervision of the Chief Operating Officer, the Director of Utilization Management is responsible for the development, implementation and monitoring of a comprehensive Utilization review, Social Work, ER Care Coordination and Case Management program. The Director must maintain an ethical and professional manner during performance of all duties.
Direct utilization management, social work and case management activities within the hospital to ensure compliance with standards of care/practice.
Supervise day to day activity of department staff to ensure integration of information and avoid duplication of work.
Assist to prioritize identified problems and present potential solutions to resolve problems.
Coordinate data retrieval for utilization /resource/case management. Maintain statistics related to hospital and medical staff utilization management.
Assist the UM committee to implement appropriate facets of UM plan.
Assist in the education of the hospital and medical staff regarding utilization/social services/case management.
Keep abreast of current regulatory requirements for utilization management, including JCAHO, Medicare, third party payers, and PRO.
Keep administration informed regarding status of utilization activities.
Perform other duties as assigned.
Coach and teach staff and consistently provide leadership to inspire and motivate staff to pursue advanced education and certification.
Ensure staff satisfaction and retention.
Ensures effective staff performance evaluation system and provides constructive feedback.
Understand hospital-wide objectives and priorities; able to link unit goals and operations to institutional goals.
Maintains appropriate standards for discipline and termination.
Coordinate documentation improvement activities within the departments of Utilization Management.
Complete chart audits for Parallon on a daily basis.
Coordinate the process for implementation of the Two-Midnight Rule Medicare Attestation Statements.
Education: Minimum of Bachelor's Degree in clinically related field. Knowledge of management principles as well as hospital operations and organization.
License/Certification: Must be a licensed Registered Nurse in the Commonwealth of Virginia. BLS certifications is required.
Special Qualifications: Knowledge of current utilization management principles, third party payor review requirements, age specific principles, discharge planning process. Excellent communication skills. Knowledge of clinical databases and strong assessment skills. Ability to develop smooth working relationships with physicians and their office staff.
JobCase Management/Social Services
Work Schedule Day shift, 7-10 hr/shift, weekdays only