This position will oversee the daily operational, staffing and scheduling activities of the Case Management department. In collaboration with the department manager and Director, the team leader will oversee performance and risk management of the Case Management department. They will assist in the alignment of departmental priorities in collaboration with the manager, director and Children's initiatives. They will implement, coordinate and evaluate the operational and personnel activities of staff members. The Team Leader, Case Management will spend 60% of their time in staffing assignments and 40% of their time in administrative/leadership, recognizing that at least 10% of their time in staffing assignment is still spent coaching, mentoring, and developing staff.
JOB SPECIFIC RESPONSIBILITIES:
- Oversee the Case Management staff, communicate with third party payers, ensure process supports reimbursement for authorized care. Problem solves complex patient pre-certification or authorization situations. Directly communicate with attending physicians to resolve complex cases. Coach staff on communication with physicians and other members of the multi-disciplinary team to help facilitate coordination of care, quality patient care and early discharge planning. Oversight and trending of inpatient denials, avoidable days and length of stay. Assist in the recruitment of employees, evaluations (PEAC's) and time off request of employees. Assist in employee recognition.
- Support staff in providing quality service: promote adequacy of staffing and services for identified and assigned patient populations. Provide orientation and ongoing staff development and education. Facilitate technology resources and tools to enable the team to work efficiently and accurately. Coach and mentor staff on care coordination and early intervention for discharge planning; assist in difficult situations and discharges.
- Actively participate on hospital and system wide committees and councils. Provide Case Management input as appropriate. Partner with other departments to ensure delivery of high quality and cost effective outcomes. Communicate to Case Management staff initiatives and responsibilities of other departments. Share data with staff and other departments as appropriate. Work in partnership with the Case Management Assistants.
- Process and performance improvement - ongoing refinement of departmental goals, priorities and initiatives. Identify opportunities to standardize and/or create efficiencies of the delivery of care. Promote collaboration with all disciplines and improve communication and collaborative process. Performs data collection and analysis for trending and auditing.
SPECIFIC KNOWLEDGE, SKILLS, AND ABILITIES:
- Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
- Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
- Meet patient and patient family needs; take responsibility for a patient's safety, satisfaction, and clinical outcomes; use appropriate interpersonal techniques to resolve difficult patient situations and regain patient confidence.
- Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
- Develop and use collaborative relationships to facilitate the accomplishment of work goals.
- Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
- Provide feedback, instruction, and development guidance to help others excel in their current or future job responsibilities; plan and support the development of individual skills and abilities.
- Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
- Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
- Effectively manage one's time and resources to ensure that work is completed efficiently.
- Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
- Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self impose standards of excellence rather than having standards imposed.
- Assimilate and apply new job-related information in a timely manner.
- Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.
LICENSES and CERTIFICATIONS:
Certified Case Manager, preferred.
Registered Nurse in the State of Texas, required.
- Minimum of 4 - 5 years of job related experience in case management, utilization management, acute care or quality improvement in a healthcare environment, required.
- 1 - 2 years of demonstrated leadership experience, preferred.
Two-year Associate's degree or equivalent experience, required.
Four-year Bachelor's degree or equivalent experience, preferred.
Light - Exerting up to 20 lbs. occasionally, 10 lbs. frequently, or negligible amounts constantly and may require walking or standing to a significant degree.