Director Case Management
About Steward Health Care
Nearly a decade ago, Steward Health Care System emerged as a different kind of health care company designed to usher in a new era of wellness. One that provides our patients better, more proactive care at a sustainable cost, our providers unrivaled coordination of care, and our communities greater prosperity and stability.
As the country's largest physician-led, minority-owned, integrated health care system, our doctors can be certain that we share their interests and those of their patients. Together we are on a mission to revolutionize the way health care is delivered - creating healthier lives, thriving communities and a better world.
Steward is among the nation’s largest and most successful accountable care organizations (ACO), with more than 5,500 providers and 43,000 health care professionals who care for 12.3 million patients a year through a closely integrated network of hospitals, multispecialty medical groups, urgent care centers, skilled nursing facilities and behavioral health centers.
Based in Dallas, Steward currently operates 33 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, and Texas.
Reports to Administrative Director of Patient Care Management and is responsible for planning, organizing and directing Hospital Social Work and Case Management, Pre-Access programs in accordance with the federal, state and local regulations. Determines scope and emphasis of the programs, and maintains cooperative working relationships with other hospital departments and outside agencies in order to coordinate provision of health and medical care services. Guides program of staff development and ensures staff awareness of available community resources.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
1. Consistently supports and communicates the Mission, Vision and values of St. Joseph Medical Center.
2. Follows the St. Joseph Medical Center Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
3. Promotes a culture of safety for patients and associates through proper identification, proper reporting, documentation and prevention of medical errors in a non-punitive environment.
4. Develops and implements departmental policies and procedures, and provides professional and administrative direction necessary to ensure effective and efficient delivery of services. Ensures compliance with all regulatory agency requirements.
5. Plans, develops and implements short and long range goals and objectives consistent with hospital goals and objective.
6. Develops plans to accomplish agreed upon goals and objectives and prepares, secures approval of and administers capital and expense budgets which provide for attainment of same.
7. Develops and maintains cooperative working relationships with various hospitals departmental and outside agency personnel in order to coordinate department functions with other patient services, gather and exchange patient information, elicit cooperation and minimize duplication of services.
8. Interviews, hires, orientate trains, evaluate the performance of and, when necessary, disciplines and discharges subordinate personnel.
9. Establishes management control procedures including record maintenance, report preparation, follow-up procedures and so forth. Prepares regular and special reports and analyses indicating departmental activity and needs of patients serviced in order to ascertain extent to which departmental goals are being achieved.
10. Overseas development and implementation of educational and orientation programs for staff and other Hospital Associates.
11. Develops and maintains programs providing field work experience for social work and nursing students from affiliated colleges.
12. Conducts staff meeting to gather and exchange information, evaluate services provided and recommend alternate methods and referral sources to provide patients with needed services.
13. Represents Hospital and designed departments at various committee, professional or community organization meetings in order to assist in developing new programs and policies for improved delivery of services.
14. Provides guidance and assistance with more complex cases.
15. Maintains knowledge of current trends and developments in the field by reading appropriate books, journals, other literature and attending related seminars and conferences.
16. Reviews financial reports for Medicare, Medicaid and Managed Care patients. Identifies problems DRG´s and departments that are encountering utilization problems and makes recommendations to resolve identified problems.
17. Discusses when necessary and offers solutions when possible to resolve with patients and/or family any grievances with the hospital in order to eliminate or diminish potential liability claims.
18. Assures that all DNV and other regulatory agency requirements are met.
19. Provides updated information relating to DRG´s, HCFA regulations, legislative requirements and DNV standards to Administration, Medical Staff and hospital departments.
20. Ensures that Case Managers provides quarterly analysis on Length of Stay, average cost and patient outcomes.
21. Ensures that Case Managers track re-admission rate of patients discharged and reasons.
22. Ensures that Case Managers track ancillary charges in excess of norm for Managed Care patients. Utilize trend information to identify unusual DRG´s/diagnosis, problematic DRG.
23. Ensures that Case Managers identify High Risk patients, re-admissions and progressive chronic illness.
24. Supportive of the compliance program set forth by Steward Healthcare and demonstrated by:
a. Upholds the Standards of Conduct and Corporate Compliance.
b. Adheres to dealing appropriately and fairly with employee misconduct.
c. Enforces all compliance policies as they pertain to his/her area.
d. Provides and assures timely compliance education as requested by the Regional Compliance & Safety Officer and/or through corporate initiatives.
25. Sets an example to all staff in their daily activities.
26. Supports, reviews, and understands DNV’s compliance activities and expectations.
MINIMUM KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED
· Five years Nursing experience or Master’s experience, preferably in a hospital or healthcare setting.
· Three years supervisory experience.
·RN Licensed in the State of Texas.
EDUCATION & TRAINING:
· Level of knowledge normally acquired through the completion of a Nursing or related field.
· Interpersonal skills necessary for effective leadership of assigned personnel and in order to represent department to all levels of Hospital personnel and a variety of community agencies when coordinating patient care.
· Analytical skills necessary in order to develop departmental policies and procedures, prepare and administer budgets, evaluate quality of services provided and so forth.
Steward Health Care is proud to be a minority, physician owned organization. Diversity, equity, inclusion and belonging are at the foundation of the care we provide, the community services we support and all our employment practices. We do not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, and or expression or any other non-job-related characteristic.