In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an ‘owner’ of Genesis and keep our patients at the center of everything we do - always.
Work Shift:
Varied Shift (United States of America)Scheduled Weekly Hours:
40Department:
Inpatient Care ManagementOverview of Position:
Responsible for developing, planning, evaluating, and coordinating comprehensive patient care across the continuum, to enhance quality patient care while simultaneously promoting cost-effective resource utilization. Provides director-level oversight of Inpatient and ED Case Management, Utilization Management and Clinical Documentation Integrity programs, ensuring alignment with organizational goals and regulatory requirements. Monitors patient care, including utilization, quality assurance, discharge planning, continuity of care, and case management activities, and ensures that these functions are integrated into overall hospital operations. Coordinate and monitors activities with appropriate members of the health care team to promote efficient use of hospital resources, facilitate timely discharges, prevent and control infections, promote quality patient care, and reduce risk and liability. Collaborates closely with coders and revenue cycle teams to optimize clinical documentation and support accurate coding, reimbursement, and compliance initiatives.ESSENTIAL DUTIES
1. Responsible for identifying tracking mechanisms in order to evaluate and achieve optimal financial outcomes, to enhance quality patient care, and promote cost-effective resource utilization.
2. Uses data to drive decisions, plan, and implement performance improvement strategies for case management, utilization management, and clinical documentation integrity
3. Coordinates daily activities of the Case Management, UM, and CDI Department in order to promote quality patient care, efficient use of hospital resources, facilitate timely and adequate discharges, and reduce risk and liability.
4. Investigates and initiates follow-up on utilization denials, contract negotiations, and external regulatory agencies’ requirements.
5. Directs operations of our Physician Advisor Program, including analysis of performance through reporting and committee involvement and oversight.
6. Actively serves on hospital committees and teams and facilitates opportunities for employees to do the same.
7. Develops, performs, and improves personal and departmental knowledge of computer software and reporting functions.
8. Organizes and oversees the maintenance of denial and appeal activity. Follows up with physicians and others when indicated.
9. Prepares or coordinates the preparation of periodic and special reports required by various agencies, insurance contracts, and for hospital committees.
10. Analyzes and trends data results in order to incorporate efforts and information results with existing systems to optimize the efficiency of operational systems through strategic quality leadership.
11. Facilitates growth and development of the case management program, utilization management ( including physician advisor program and clinical documentation integrity (CDI), in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities, as needed.
12. Develop new resources where gaps exist in the system as identified through research and data analysis to meet and enhance the quality/efficiency of comprehensive patient care and/or basic human needs for the community.
13. Interact with Corporate Consulting and Business office on issues such as contracting, billing, reimbursement, denials, and physician reports cards, and collaboratively initiate improvements related to these areas.
14. Maintains hospital compliance with the Quality Improvement Organization (QIO) and CMS guidelines.
15. Maintains professional knowledge by participating in educational seminars and opportunities.
16. Participates in Population Health work at an organizational level, including active involvement with the System-Wide Care Management Team and Value-Based Care Delivery
QUALIFICATIONS
1. Master’s degree in nursing, Healthcare Administration, or Business Administration required.
2. Current Ohio RN licensure (or active multi-state licensure).
3. Three (3) years of management or demonstrated leadership experience required.
4. Knowledge of prospective payment systems, managed care, infection control surveillance, patient care, disease processes, discharge planning, and continuum of services offered within Genesis and externally. Knowledge of coding, mid-revenue cycle, CDI, physician advisor and payor relations.
5. Ability to perform data analysis and to utilize computer systems to record and communicate information to other services.
6. The ability to lead collaboration with other leaders in the organization, especially about the delivery of high-quality, timely, and right site of care.
7. Excellent leadership, verbal and organizational skills to order to steer the case management process.
PATIENT CENTERED CARE & BEHAVIORAL EXPECTATIONS
1. Living the Genesis Mission, Vision and Values
• Performs work in a manner that is quality focused.
• Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect.
• Results oriented and focused on achievement of objectives.
• Acknowledges and responds to the diversity of people and the situation.
• Encourages peers (others) to be owners of change.
• Always makes the effort to anticipate and exceed customer needs and expectations.
• Possesses the ability to engage others with patience and understanding.
• Acts in a manner that creates positive first and lasting impressions.
• Demonstrates the ability to own issues until they are resolved.
2. Patient Centered Care (patients/families, physicians, co-workers, all other internal/external customers)
• Introduces self and role…connects with everyone.
• Communicates effectively (i.e. advising others of actions, pertinent information, time durations, etc.) and asks for feedback.
• Asks for and anticipates needs and concerns of others.
• Maintains a positive work environment for staff and a healing environment for patients (i.e. safe, clean, quiet, etc.)
• Maintains the dignity and privacy of each person; manages confidential/sensitive information appropriately.
• Responds to requests in an appropriate and timely manner.
• Exits patient/customer encounters courteously, asking if there are additional needs that can be addressed.
3. Promotes Patient and Employee Safety
• Demonstrates safe Patient Handling (i.e. transfers, transport, care administration, nutrition, medication, etc.)
• Demonstrates safe Materials Handling (i.e. appropriate use and disposal of chemicals, infectious wastes, etc.)
• Demonstrates appropriate knowledge of Infectious Disease precautions and use of proper protective equipment
• Demonstrates Slips/Trips and Falls Awareness.
• Actively contributes to maintaining a safe, clean and quiet environment.
WORKING CONDITIONS/PHYSICAL REQUIREMENTS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Must have excellent written and verbal communication skills as well as the ability to observe, access, guide and evaluate others.
2. Must be able to hear, speak, see and to coordinate motor skills.
3. Must be able to climb, lift25 pounds, stoop and bend.
4. Ability to collect data, interpret findings, set priorities and carry out established plan.
5. Ability to read, write and utilize manual and computerized systems of documentation.
6. Must read a significant amount of information in a relatively short period of time.
Thank you for your interest in employment at Genesis. Genesis is committed to being an equal opportunity employer. Selection of applicants for employment is based only on qualifications and the requirements of a specific job.