Manager - Case Management - Utilization Management (1.0 FTE, Days)
1.0 FTE, 8 Hour Day Shift
At Stanford Children’s Health, we know world-renowned care begins with world-class caring. That's why we combine advanced technologies and breakthrough discoveries with family-centered care. It's why we provide our caregivers with continuing education and state-of-the-art facilities, like the newly remodeled Lucile Packard Children's Hospital Stanford. And it's why we need caring, committed people on our team - like you. Join us on our mission to heal humanity, one child and family at a time.
This paragraph summarizes the general nature, level and purpose of the job.
Plans, organizes,manages, evaluates and provides overall administration, direction, andmanagement of the staff and day-to-day activities of Case Management/Utilization Review, one of two major organizational components (the other being SocialWork Services) within the hospital. The Case Management Manager acts as a consultant to the clinical team, service lines and other departments, and participates in program development and quality improvement initiatives. A hospital-based Case Management system has as its primary goal to ensure the most appropriate use of services by patients and, toward that end, to avoid duplication and misuse of medical services, control costs by reducing inefficient services, and improve the effectiveness of care delivery. Objectives are to facilitate timely discharge; prompt, efficient use of resources; achievement of expected outcomes; collaborative practice; coordination of care across the continuum; and performance/quality improvement activities that lead to optimal patient outcomes.
The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.
Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.
Must perform all duties and responsibilities in accordance with the Service Standards of the Hospital(s).
The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned. Employeesmust abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patients rights and ethical treatment, safety and security of physical environments, emergencymanagement, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings. Must perform all duties and responsibilities in accordance with the Service Standards of the Hospital(s).
Advises the Director on the various needs of the Case Management and Utilization Review function, such as staffing needs, supplies, equipment, space and other resources needed to meet patient and staff needs. Recommends and participates in selecting outside sources for needed services. Develops andmaintains an effective systemof information, records and reports for assigned department(s) utilizing appropriate manual or electronicsystems.
Continuously assesses and improves department's performance based on "customer" needs;manages and participates in improving performance and services which benefit staff, patients and other customers. Determines fiscal requirements and assist in budget preparation for department.Monitor, verify and reconcile expenditure of budgeted funds, including the preparation ofmonthly variance reports.
Effectivelymaintains appropriate quality improvement and control programs in response to staff and patient feedback, internal standards of care and external requirements. Evaluates and implements changes based on data related to productivity, quality and outcomes for departmental projects and programs.
In collaboration with the Director, plans, develops, implements and promotes a comprehensive program of CaseManagement and utilization review activities for the hospital and clinics, including identification of Case Management issues and development of strategies, policies, and procedures for CaseManagement interventions; ensures that policies and procedures are compatible with the function and goals of SHC and whichmeet the external, regulatory and statutory requirements.
Leads and participates in program planning, identifying CaseManagement and utilization review needs, and resolving problems. Organize activities with other departments/units to ensure efficient coordination of services.
Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs.
Plans, coordinates and conducts staffmeetings to ensure compliance with established practices and regulatory requirements, to implement new policies, and provide communication to staff.
Provides leadership andmanagement to licensed nursing professionals providing CaseManagement and utilization review services and support staff. Recruits, interviews, hires, orients, and promotes staff. Responsible for the systematic evaluation of staff performance. Ensures personnel policies and procedures are followed andmonitored. Initiates corrective/disciplinary action and responds to grievances. Provides consultation,mentoring, and clinical supervision to CaseManagement staff. Advises and confers with case managers on unusual or difficult cases. Assigns, schedules, and reviews the work of Case Management staff to ensure adequate coverage.
Provides leadership and participates primarily in intradepartmental program planning, task forces, committees and performance improvement initiatives. Provides expertise and direction to staff for complex problem solving.
Provides teaching to staff to enhance clinical knowledge,maintain licensure and other areas. Ensures there are adequate ongoing education programs and training opportunities for staff with his/her area of responsibility, including orientation of new employees and relevant in-service education sessions.
Reviews and analyzes data and reports related to the provision of Case Management services.
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
Education: Master’s Degree in Nursing from an accredited college or university
Experience: Five (5) years of progressively responsible and directly related work experience
License/Certification: CARegistered Nurse (RN)
Knowledge, Skills, & Abilities
These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.
Ability to make effective oral presentations and prepare concise written reports to a variety of audiences Ability to monitor and assure the patient's access to the appropriate level of care; the right health care providers; and the correct setting and services to meet the patient's needs; promote coordination and continuity in patient health care.
Ability to provide appropriate patient care and clinical information when patients are admitted, referred, transferred, or discharged
Knowledge of applicable hospital policies, rules and regulations; requirements and standards of external accrediting and regulatory organizations; statutory requirements, includingHIPAA; contemporarymedical issues and health trends.
Knowledge of available patient services and treatment.
Knowledge of current theories, principles, practices, standards, emerging technologies, techniques and approaches in the nursing profession, and the health care system, and the responsibility and accountability for the outcome of practice.
Knowledge of financial processes of various private and public funding sources for health care services/procedures.
Knowledge of medical terminology and related levels of care and treatment.
Knowledge of principles and practices of organization, administration, fiscal and personnelmanagement Knowledge of the full continuum of care available to patients, interrelationships of the care components, and their effective integration.
Knowledge of themodels of casemanagement, including the principles and practices of discharge planning, utilization review, and quality assurance/improvement.
Knowledge of the variables that affect the processes and outcomes of patient health care.
The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job.
Equal Opportunity Employer