TITLE:  CASE MANAGEMENT & SOCIAL SERVICES LEADER

DEPARTMENT:  ADMINISTRATION                       

IMMEDIATE SUPERVISOR JOB TITLE: PRESIDENT / CNO

Position Summary:

The Case Management and Social Services Leader is responsible for handling the day-to-day operations and issues in the Case Management and the Social Services departments, including oversight of Utilization Management functions, data abstraction functions (Joint Commission Core, CMS Quality measure, Electronic Clinical Quality measure), oversight of Clinical Documentation Improvement functions, and oversight of Social Service and Discharge Planning functions.

Essential Functions:

• Responsible for oversight of the day-to-day operations in the Case Management and Social Services departments; Develops, maintains, implements and consistently enforces Case Management and Social Services departmental policies and procedures
• Prepares Case Management and Social Services departmental budgets and operates the departments within stated budgets
• Analyzes data, uses data to drive improvement, coaches to address opportunities for improvement
• Ensures the efficient rendering of services according to the hospital’s Utilization Management Plan, including the overall aspects of patterns of hospital resources
• Ensures that Social Service and Discharge Planning interventions are initiated at the earliest possible time in the patient’s hospitalization to meet the needs of the patient and optimize a positive outcome
• Oversees the DRG Assurance and Clinical Documentation Improvement programs.
• Develop in conjunction with the patient and/or family and health care team an individualized comprehensive care plan & document services provided in the record appropriate for reimbursement
• Reviews medication list and identifies area to be reconciled; refer and/or connect patients to appropriate community and health related services; Involve the patients in activities to improve their health by providing education and support to the patient about self-management tasks they can undertake to gain greater control of their health status
• Refer and/or connect patients to appropriate community and health related services
• Committees:  Clinical Documentation Improvement Committee, Utilization Management Committee, Denials Task Force, ICCU/ER Committee, Medical Staff, Medical Staff Executive Committee, Newborn/Pediatrics Committee, OB Committee, and Surgery Committee.

Non-essential Functions:

• Performs other duties assigned

Position Requirements

• RN with 3-5 years of clinical experience
• MSN Preferred
• Effective oral, written, and phone communication skills
• Works well independently with strong organization, collaboration and time-management skills
• Knowledge of clinical practices and diagnostic and treatment procedures
• Ability to use good clinical judgment, critical thinking skills, and to interpret/adapt/apply guidelines and protocols

Mental/Emotional Demands

• Exhibits strong leadership ability
• Is able to handle multiple priorities
• Uses independent discretion/decision making
• Makes good decisions under pressure
• Manages stress appropriately
• Works alone effectively
• Works with others effectively