The individual in this position has overall responsibility for operational management of the Case Management Department, Social Services and Bed Control; including staffing, budgets and plans.
The individual's responsibilities will include, but not be limited to the following activities:
a) Complying with relevant Tenet policies including Case Management and Clinical Determination Policies b) implementing and revising the UM Plan and promoting cooperation with utilization review standards by the medical staff c) Maintaining / facilitating communication between the case management department and the physician advisor on a regular basis regarding utilization review and/or quality issues d) Maintaining / facilitating communication between the case management department and the physicians as well as other members of the healthcare team e) analysis of reports: LOS, avoidable days, disputes, InterQual and associated metrics f) Responsible for implementation and compliance with all policies and regulations relating to the functioning of the case management department g) and all other duties as assigned
Attends a workshop webinar led by PMI Case Management leadership or designee that includes the Tenet Case Management Model and other topics specific to role and responsibilities.
Information used to perform job: patient data, healthcare staff documentation related to patient care, regulatory and payor requirements, budgetary and operations data
Software used to perform job: eCCM: Clinical data interface, InterQual, Case Management documentation, secure faxing, Avoidable Day tracking, Patient Medical Record and HPF, hospital specific Clinical Software, Enterprise Reporting: Decision Support reports, PMI reports, Care Discovery, Position Control
DEPARTMENT SPECIFIC DUTIES:
Priority 1. Oversee coordination of clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post- acute care) compared to evidence-based practice, internal and external requirements. (40% daily, essential),
Priority 3. Perform data gathering, analysis and reporting. (20% daily essential).
Priority 4. Remain current with relevant clinical/ case management practices. Attend and participate in meetings related to Quality, Operational and Financial improvement (20% daily, essential).
All staff assigned to department (case managers, social workers, case manager assistants, administrative assistants). Other responsibilities as assigned e.g. disaster preparedness
The metrics below provide an indication of the effectiveness of the individual in this role and may be used for evaluative purposes. The list below is not meant to be exhaustive; other relevant metrics may exist.
Compliance with Tenet Case Management policies
Obtaining valid physician order prior to bed placement
Clinical disputes - incidence and dollars
Number and type of avoidable days
At least 5 hours of CEUs per year on topics related to Case Management.
Registered Nurse with a BSN and an RN License
Extensive management and clinical experience
Experience in improving organizational performance
Experience in facilitating and leading multidisciplinary teams
Strong written and verbal communication skills
Demonstrated ability to organize and work with groups of people
Ability to present data to professional groups and institute changes based on the data presented
Demonstrates effective problem solving and decision-making skills
Minimum of 3 years of experience as a case manager
Registered Nurse with a BSN and a California RN License
Job: Managers and Directors
Primary Location: Palm Springs, California
Facility: Desert Regional Medical Center
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.