DHR Health  -  US:TX:Edinburg - Days

Summary:

POSITION SUMMARY:

Under supervision of the Vice President of the Integrated Resource Management Department, the Director manages the functions of the Resource Management program. The position is accountable to supervise the daily activities of Resource Management staff and is responsible for other duties as defined by the Vice President. The Director is on-site, available seven days a week and carries a cell phone for after hour, weekend and holidays.

 

POSITION EDUCATION/ QUALIFICATIONS­:

• Bachelor’s degree required
• Must possess a strong knowledge of nursing, case management or healthcare related field.
• Certification in Case Management preferred, or must achieve certification within 3 years of hiring.
• Supervisory experience required, 2-4 years preferred.
• Previous experience in Case Management and Discharge Planning or equivalent required.

JOB KNOWLEDGE/EXPERIENCE­:

• Requires knowledge in the areas of case management and utilization management. Experience with Managed Care preferred. Knowledge of utilization management as it relates to third-party payers.
• Experience in use of InterQual and or Milliman criteria and review processes.
• Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to utilization review and discharge planning.
• Demonstrated skills in the areas of negotiation, excels in communications (verbal and written), conflict, interdisciplinary collaboration, creative problem solving, and critical thinking. .
• Knowledge of health care financing, and data analysis.
• Must have a working knowledge of hospital operations, medical/nursing staff procedures, and hospital and community resources.
• Requires leadership skills and an ability to interact well across departments, facilities and organizations.
• Organizational, human relations, and communication skills are required
• Computer skills required with knowledge of Microsoft Office Suite.
• Bilingual – English/Spanish preferred.

Responsibilities:

POSITION RESPONSIBILITES:

• Provides leadership, education, and mentoring of Resource Management Staff.
• Provides training within the department on topics relevant to the services provided.
• Coordinates the planning of schedules, work assignments and directs the workflow for the staff.
• Participates in hiring, and oversees orientation of new staff.
• Provides/oversees training program of BSW as required by the State of Texas.
• May be called upon to undertake supervision of students, trainees or staff.
• At regular intervals reviews pertinent medical records/ logs to ensure that all information is complete
• Performs evaluations of the staff in concert with the Administrator.
• Develops corrective actions plans with staff not meeting expectations of their respective position.
• Reviews policies annually to make sure they reflect current standards and regulations.
• Participates in the development of the department budget.
• Represents Resource Management at hospital committee and work groups as requested by the Administrator.
• In accordance with departmental policy, will be required to attend relevant training courses and staff developmental programs when these are made available and recommended by senior staff/training officers.
• Maintains personal competencies needed for licensure and attending internal and external educational offerings.
• Evaluations are completed timely and provide goal setting for the future year
• Work schedules are completed timely and reflect adequate staffing.
• Provides leadership functions in absence of Vice President of Integrated Resource Mgt.
• Review biweekly staffing schedule.
• Maintains supplies equipment.
• Requests for PTO.
• Maintains departmental staffing within established budget.
• Collaborate with the multidisciplinary team to assure effective, efficient, appropriate care in order to optimize the health status and assure a smooth transition between levels of care for patients served.
• Manages staff performance related patient's transition through the system and transfers accountability to the appropriate person upon entry into another clinical service or upon discharge.
• Participates in rounds on nursing units to observe and provide direction so as to facilitate maintain resource consumption.
• Serves as a resource to associates/physicians/ Case Managers and Social Workers on issues relating to utilization of services and discharge planning.
• Assists in facilitating and implementing physician orders to aid in the timely completion of patient care along the continuum.
• Provides training within the department on topics applicable to the services provided
• Performs quality assessment reviews and studies both concurrently and retrospectively as required by the hospital’s PI plan, TJC standards, CMS and third-party payer regulations.
• Applies generic quality screens/indicators concurrently to patient medical records and accurately abstracts relevant patient care data to determine if quality screens are flagged. Performs first line reviews on potential quality issues as requested by the Administrator.
• Refers all other potential quality of care issues identified, not reviewed, as part of the quality assessment screening to the physician advisor to facilitate timely follow up.
• Monitors and oversees avoidable day data for system Performance Improvement
• Refers quality issues to the Resource Management Administrator, CMO and/or PA appropriately.
• Identifies and reports opportunities to improve care for patients, including patient complaints and any unusual patient care issues.
• Assists the Vice President in establishing and maintaining an effective Denial Management Program and process
• Organize and conduct meetings and training sessions.
• Member of Denial Management Team
• Data Management
• Demonstrate ability to collect, analyze and present data accurately as appropriate to position
• Prepare clear and concise oral and written reports
• Organize and provide materials in compliance with laws, regulations and policies
• Provide at minimum, monthly reports to Leadership, of discrepancies and other data as requested.
• Maintains current knowledge of case management, utilization management, and discharge planning, as specified by federal, state, and private insurance guidelines.
• Maintains a working knowledge about the requirements of the payers most frequently seen with the patient population
• Maintains a working knowledge of the resources available in the community for patients/families.
• Maintains current nursing licensure CEU credits.
• Maintains knowledge of InterQual and Milliman criteria.
• Performs related duties as required

Other information:

LINES OF REPSONSIBILITES:

(Chain-of-command)

1. Director of Resource Management → 2. Vice President of Resource Management

 

 

CUSTOMER SERVICE:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.

 

AGE SPECIFIC:

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.

AMERICANS WITH DISABILITIES ACT: (ADA):

A. Essential Duties: Indicated by bold print within performance standards, preceding individual numbered criteria.

The following table provides physical requirements that will be associated with, but not limited to, this position:

· Light/moderate lifting up to 20 lbs, from the floor to shoulder height.	· Yes	· Kneeling	· Yes
· Must be able to assist other employees with lifting more than 20 lbs.	· Yes	· Walking	· Yes
· Light/moderate carrying up to 20 lbs.	· Yes	· Standing/Squatting	· Yes
· Straight pulling	· Yes	· Sitting	· Yes
· Pulling hand over hand	· Yes	· Pushing	· Yes
· Repeated bending	· Yes	· Stooping/Bending	· Yes
· Reaching above shoulder	· Yes	· Climbing Stairs	· Yes
· Simple grasping	· Yes	· Climbing Ladders	· No
· Dual simultaneous grasping	· Yes	· Depth Perceptions needed	· Yes
· Ability to see	· Yes	· Identify Colors	· Yes
· Operating office equipment	· Yes	· Twisting	· Yes
· Operating mechanical equipment	· Yes	· Crawling	· No
· Ability to read and write	· Yes	· Ability to Count	· Yes
· Ability to hear verbal communication without aid	· Yes	· Operating Personal Vehicle	· Yes
· Ability to comprehend written/verbal communication	· Yes	· Other: Ability to deal with stress	· Yes
· OSHA Category	· III	·	·

B. Working Conditions: The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

D. Aptitudes: HIGH 1 2 3 4 5 6 LOW

Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3

Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3

Numerical: Ability to perform arithmetic operations quickly and accurately. 2

Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2

Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3

Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2

Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3

Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3

Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3

Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3

Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3

I have read and reviewed my job description with my supervisor or designee and I understand the job I am expected to perform.

If applicable ____________ certification will be completed within _________ time frame of hire/transfer date.

Employee Signature: ________________________________ Date: ____________________

Transfer/Hire Date Effective: ________________________.