Job Description

Location: Morton Hospital
Posted Date: 1/9/2023

At Steward Health Care System, we are committed to improving the health of our communities by delivering exceptional, personalized behavioral health care with dignity, compassion and respect. Our continued focus on the patient experience informs our caregivers in how to provide care that is respectful of and responsive to individual patient and family preferences, needs and values.

We dedicate ourselves in the communities we serve to delivering affordable health care to all and being responsible partners. No matter what your role, as a member of the Steward family, you are a specialist in the making every patient and family feel right at home, every co-worker a key to our success, and every referring practice, a team of prized colleagues.

In support of this, we commit ourselves to the following values:

Compassion

Accountability

Respect

Excellence

Stewardship

If you are seeking a fast-paced, challenging position in an organization committed to achieving and maintaining a standard of excellence in all we do, our organization may be a good fit for you.

***Director Care Management Full Time

POSITION SUMMARY:

Responsible for reviewing admissions and contend stays to ensure appropriate utilization of healthcare resources. Utilize the major care management processes i.e. assessment, planning, facilitation, and advocacy to facilitate a safe, effective and efficient patient centered discharge plan. Participates in and supports the Hospital’s Performance Improvement (PI) activities.

KEY RESPONSIBILITIES:

  • Provides expert guidance to the medical nursing and rehab staff as well as other Hospital departments regarding Hospital criteria, insurance regulations, care coordination efforts and discharge planning activities.
  • Performs admission and concurrent utilization management using Hospital approved criteria as a guide for determination of appropriate level of care and for evaluation of health care resources utilization
  • Completes/communicates accurate insurance utilization reviews to third party payers
  • Facilitates effective and appropriate discharge plans
  • Continually updates knowledge of community services, resources, programs, and facilities in order to facilitate effective discharge plans.
  • Participates in performance improvement measurements and initiatives including identification of variances/delays
  • Participates in inter-departmental committees, focus groups, task force or other special projects as requested
  • Participates in mandatory education programs

Responsibility for Pre-admission and Admission Review:

  • Reviews the clinical records of all admitted patients for appropriateness of admission, level of care, and utilization of appropriate Hospital resources
  • Screens urgent, elective and emergent admissions and transfers and directs the patient to the appropriate setting along the continuum of care in collaboration with a physician and third party payers if applicable
  • Refers patients / families to the appropriate community-based services/programs if not Hospital level of care.

Responsibility for Care Coordination, Resources utilization and Discharge planning:

  • Identifies patients that may need discharge planning services using the Department’s high risk criteria
  • Monitors the patient’s care concurrently for appropriateness using Interqual criteria
  • Identifies and communicates patients not meeting Hospital level of Care to the patient’s attending physician, the Department Director and Medical Advisor
  • Collaborates with other disciplines to assess, coordinate and plan for discharge
  • Conducts utilization review in a timely manner and communicates with third party payers in a timely and accurate manner
  • Identifies quality of care and documentation issues and reports the concerns to the appropriate person/department
  • Communicates timely and effectively with the Patient Financial Services Department to ensure appropriate and accurate billing
  • Completes insurance and Masspro appeals and reconsiderations in an accurate and thorough manner
  • Identifies opportunities for improving patient resources utilization
  • Effectively communicates and collaborates with departmental social workers, external liaisons and post acute care facilities
  • Consistently involves the patient, family or legal representative in all aspects of care coordination and discharge planning
  • Refers patients and/or families for social services consultation related to issues of crisis intervention, psycho-social problems, financial and discharge palling activities.

Responsibility for Performance improvement and Compliance with Federal, State and JCAHO regulations:

  • Updated knowledge of Hospital policies and procedures
  • Maintains current knowledge of JCAHO standards and National Patient Safety Goals
  • Attends hospital educational programs including any mandates programs
  • Participates in JCAHO activities
  • Participates in departmental Performance Improvement initiatives
  • Collects, conducts and reports data as directed
  • Identifies and reports quality of care issues including delay days per Hospital reporting system
  • Completes required documentation as per policy or regulation and in a timely manner
  • Identifies opportunities for improvement and communicates to department manager

Management of Time and Resources:

  • Completes work assignments within an acceptable time frame.
  • Uses time and resources to the best possible advantage for successful completion of job responsibilities.
  • Develops and maintains efficient working relationships.
  • Is reliable in respect to attendance.
  • Is Reliable in respect to punctuality.
  • Recognizes the importance of team efforts and partners with others to achieve positive outcomes.

Quality:

  • Is part of a team effort to insure quality services.
  • Offers creative solutions or alternatives to issues or concerns.
  • Produces quality results.
  • Continually strives to improve the quality of work.
  • Accepts responsibility for all work performed and takes appropriate corrective action as needed.

CUSTOMER SERVICE SKILLS:

  • Is cooperative in interactions, treating customers with courtesy, respect and compassion.
  • Is patient when responding to questions and answers questions appropriately.
  • Responds to requests in a timely manner.
  • Handles interruptions in a skillful way.
  • Maintains a professional appearance and demeanor.
  • Strives to prevent/resolve customer concerns to the customer’s satisfaction.

REQUIRED KNOWLEDGE & SKILLS:

  • Demonstrated leadership ability
  • In depth knowledge of care management and/or utilization management
  • Excellent written and oral communication skills
  • Excellent interpersonal and organizational skills
  • Knowledge of Federal and State regulations related to discharge planning and patient’s rights
  • Financial acumen
  • Critical thinking and problem solving ability

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

  • Registered Nurse licensed in Massachusetts
  • Minimum of 5 years acute care experiences
  • Minimum of 3 years experience in Utilization review, Discharge planning and / or Case management

Preferred Qualifications:

  • Bachelor’s Degree in a healthcare related program
  • Certification in Care Management
  • Membership in a related professional organization, pursuing advanced educational preparation or certification

Additional Information

Important COVID message

Please note, Morton Hospital is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment - with confidence and without fear. Our Safe and Ready program consists of a rigorous [five-point] standard ensuring patient safety, confidence and convenience: Expanded hours will allow previously cancelled procedures to be scheduled as quickly as possible. Any COVID-19 related care takes place in designated areas away from other patients and their families. Emergency Departments are reorganized to be a safe place to treat all emergency patients. A stringent cleaning policy has been implemented throughout the hospital. A strictly controlled visitor and masking policy is required for patient safety. You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online