Oversees coordination of patient care to facilitate development,
monitoring and refinement of treatment plan to achieve identified
patient goals and outcomes. Assumes responsibility for ongoing,
effective operations for Case Management. Supervises employees
involved in concurrent and retrospective utilization review
activities and the identification of discharge planning needs.
Communicates effectively with nursing and other ancillary
departments to ensure proper utilization and documentation.
Provides mechanisms to monitor and enforce compliance with CM
program. Ensures regular, complete and timely reporting of case
management performance outcomes. Assures that the clinical programs
are responsive to the needs of payors, patients and families.
Represents and promotes Kindred Healthcare to the provider
community and to local educational institutions when
Ensures the development of standards and case management practices
are integrated and are consistent with current research,
professional standards and regulatory requirements affecting
Assures that the clinical programs are responsive to the needs of
payors, patients and families. Designs, implements and monitors
process to assure optimal utilization of resources and
Participates as a management team member in the Utilization
Management Committee Presents reports to Utilization Management
Committee, Quality Council, Medical Executive Committee and
Governing Board as required.
Identifies opportunities to achieve average length of stay targets
based on available comparative data and benchmarks. Aggregates and
analyzes hospital utilization services statistics and recommends
corrective action, if required.
Ensures areas of responsibility are operating in compliance with
CMS, State and JCAHO regulations and standards and with Kindred
policies, including documentation and record requirements. Actively
participates in surveys and audits.
Graduate of an accredited program required.
RN or BSN preferred; OR Masters in Social Work with licensure as
required by state regulations; OR Bachelors in Social Work with
licensure as required by state regulations
Healthcare professional licensure required as Registered Nurse, OR
Licensed Clinical Social Worker (LCSW) OR Licensed Social Worker
Appropriate certification in Case Management preferred.
Minimum three years experience in Hospital Case Management.