Signature Healthcare, MA
Director Case Management
Signature Healthcare, MA, Brockton, Massachusetts, United States, 02411
Overview
The Director of Case Management is responsible for planning, directing, and managing the activities of the Case Management Program for Signature Healthcare (SHC) and Signature Medical Group. This role includes development and supervision of staff (RNs, LPNs, social workers, and non-clinical support), evaluation and maintenance of case management skills and outcomes, management of policies and procedures, and ensuring adherence to key model components that drive outcomes. The position works collaboratively with the multidisciplinary team to assure quality, timely, and cost-efficient care for patients, their families, and other SHC customers. Responsibilities
Develops, implements, and evaluates the strategic plan for the organization-wide Case Management system and process for all services across Signature Healthcare. Provides operational supervision of the Case Managers, Social Workers, and supports ongoing problem solving. Establishes tools, processes, and systems to optimize all roles. Assists in discharge planning and collaboration with the clinical healthcare team across the patient care continuum, including preadmission and post-hospital discharge. Participates in daily care rounds to evaluate and facilitate discharge planning, develops initial discharge plans, reviews with patients and families, and reassesses daily during rounds. Proactively builds post-hospital referrals and coordinates with Transition Care Coordinators to facilitate timely discharge. Acts as a change agent to improve patient flow and reduce service delays; monitors on-site case managers and utilization review staff for compliance with hospital standards and denials management. Leads education for staff and community physicians on utilization issues; participates in meetings with payors and JV partners. Provides training to staff on case management methods and ensures monitoring mechanisms identify areas for improvement in resource utilization. Plans and develops systems in response to payor requirements; monitors payor denials and develops remediation plans to reduce denials. Uses information systems to develop reports monitoring utilization and supports the Care Maps project; liaises with payors and external review agencies for medical record review, denials, appeals, and reconsideration hearings. Works with the physician advisor to intervene in cases with sub-optimal resource use; aggregates information for various audiences to demonstrate hospital resource utilization. Assists with department budget preparation and presents information on resource utilization to the Quality Improvement Committee. Leads teams in response to identified opportunities in resource utilization and collaborates with Nursing and Social Work to ensure discharge-planning activities are comprehensive and effective. Works with Finance to ensure timely and accurate reimbursement-related information. Qualifications
Minimum 5+ years of progressive management experience with demonstrated goal-oriented outcomes; minimum 7 years of acute clinical experience; proven leadership and change management experience. Strong analytical abilities; ability to strategically plan, build consensus, and solve problems; strong judgment in decision making. Excellent communication skills; ability to convey complex information professionally and courteously; strong interpersonal skills; ability to interact effectively with diverse groups. Administrative skills to supervise and develop staff, plan, organize, direct, and evaluate; proficiency in data analytics and understanding of clinical and financial outcomes. Ability to work in a fast-paced environment with performance agility; fluent in English; proficient with computers and hospital software, Microsoft Office, and related applications. Education
RN with Master’s Degree; Current License as Registered Nurse in the Commonwealth of Massachusetts Additional Details
Exposure Category: It is reasonable to anticipate occupational exposure to blood-borne pathogens as part of SHC Brockton Hospital and Signature Medical Group activities.
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The Director of Case Management is responsible for planning, directing, and managing the activities of the Case Management Program for Signature Healthcare (SHC) and Signature Medical Group. This role includes development and supervision of staff (RNs, LPNs, social workers, and non-clinical support), evaluation and maintenance of case management skills and outcomes, management of policies and procedures, and ensuring adherence to key model components that drive outcomes. The position works collaboratively with the multidisciplinary team to assure quality, timely, and cost-efficient care for patients, their families, and other SHC customers. Responsibilities
Develops, implements, and evaluates the strategic plan for the organization-wide Case Management system and process for all services across Signature Healthcare. Provides operational supervision of the Case Managers, Social Workers, and supports ongoing problem solving. Establishes tools, processes, and systems to optimize all roles. Assists in discharge planning and collaboration with the clinical healthcare team across the patient care continuum, including preadmission and post-hospital discharge. Participates in daily care rounds to evaluate and facilitate discharge planning, develops initial discharge plans, reviews with patients and families, and reassesses daily during rounds. Proactively builds post-hospital referrals and coordinates with Transition Care Coordinators to facilitate timely discharge. Acts as a change agent to improve patient flow and reduce service delays; monitors on-site case managers and utilization review staff for compliance with hospital standards and denials management. Leads education for staff and community physicians on utilization issues; participates in meetings with payors and JV partners. Provides training to staff on case management methods and ensures monitoring mechanisms identify areas for improvement in resource utilization. Plans and develops systems in response to payor requirements; monitors payor denials and develops remediation plans to reduce denials. Uses information systems to develop reports monitoring utilization and supports the Care Maps project; liaises with payors and external review agencies for medical record review, denials, appeals, and reconsideration hearings. Works with the physician advisor to intervene in cases with sub-optimal resource use; aggregates information for various audiences to demonstrate hospital resource utilization. Assists with department budget preparation and presents information on resource utilization to the Quality Improvement Committee. Leads teams in response to identified opportunities in resource utilization and collaborates with Nursing and Social Work to ensure discharge-planning activities are comprehensive and effective. Works with Finance to ensure timely and accurate reimbursement-related information. Qualifications
Minimum 5+ years of progressive management experience with demonstrated goal-oriented outcomes; minimum 7 years of acute clinical experience; proven leadership and change management experience. Strong analytical abilities; ability to strategically plan, build consensus, and solve problems; strong judgment in decision making. Excellent communication skills; ability to convey complex information professionally and courteously; strong interpersonal skills; ability to interact effectively with diverse groups. Administrative skills to supervise and develop staff, plan, organize, direct, and evaluate; proficiency in data analytics and understanding of clinical and financial outcomes. Ability to work in a fast-paced environment with performance agility; fluent in English; proficient with computers and hospital software, Microsoft Office, and related applications. Education
RN with Master’s Degree; Current License as Registered Nurse in the Commonwealth of Massachusetts Additional Details
Exposure Category: It is reasonable to anticipate occupational exposure to blood-borne pathogens as part of SHC Brockton Hospital and Signature Medical Group activities.
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