FISHERMEN’S HOSPITAL  MARATHON, FL TITLE:                Director of Case Management  PURPOSE:  Performs review of patient\'s medical records for the purpose of appropriate utilization of hospital beds and services, compliance with Medicare, Medicaid, and third party payor regulations and guidelines.  Assists Resource Managers to provide prompt and effective discharge planning; screens all admissions for appropriate level of care setting.  Supervises the Resource Managers to insure the quality of work and continuity of patient care. Serves as a liaison between hospital administration, Resource Management, physicians, and staff in meeting criteria of care for core measures patients as mandated by CMS and JCAHO standards. Oversees and assists with abstraction of data on core measures patients on a quarterly basis. JOB RELATIONS:  A.        Responsible to the CFO B.         Supervises all other Resource Managers C.        Inter-relationships with Medical Staff, Nursing, Hospital Personnel, Outside       Agencies, Patients and Families required. ESSENTIAL FUNCTIONS:  1.         Monitors inpatient records to insure quality utilization of hospital resources. 1:1       Conducts admission and continued stay reviews according to established procedure       and departmental standards. 1:2       Screens all patients using approved InterQual criteria referring cases when         necessary as stated in the InterQual guidelines. 1:3       Provides clinical information to private review organizations and maintains          communication as required to obtain certification for the admission and continued    stay authorizations. 1:4       Establishes effective working relationship with medical and hospital staff to educate        and coordinate usage of resources and services. 1:5       Notifies supervisor of potential or identified problem areas that concern length of            stay or financial issues. 2.         Assesses patients identifying any discharge needs, coordinating post hospital plans to facilitate a timely discharge when medically stable. 2:1       Screens all cases for early identification of \"high risk\" patients according to         established protocols. 2:2       Meets regularly with nursing personnel and Resource Managers for discharge planning and information exchanges as evidenced by timeliness of discharge. 2:3       Assures patient care staff, Resource Managers and physician are kept informed of         discharge plans by providing a continued system of communication through             documentation in the medical record according to established procedure. 2:4       Keeps current of community resources as demonstrated by providing accurate   information on the resources to the patient care staff, patients and family. 2:5       Demonstrates patient and family involvement in the discharge planning process as           indicated in the progress notes. 3.         Maintains interdepartmental records, confidentiality of information and submits reports as indicated. 3:1       Assures completion of all discharge documentation, referral agency forms, and state       required forms prior to the discharge of the patient, when discharge orders are          written during working hours of the Resource Management Department 3:2       Maintains confidentiality of patient and department information, releasing only in             accordance with the hospital policy and/or the approval of the department director. 3:3       Assures the security of the department files at the end of each work day to protect         confidential information as indicated by a locked office. 4.         Maintains commitment to professional growth and competency, supporting the Fishermen’s philosophy of team spirit and communication to insure quality of care and human dignity at the medical center. 4:1       Communicates with physicians, co-workers and other departments to insure that the                              needs of the patient are met in a timely manner through positive interaction showing                    dignity and respect as evidenced by lack of complaint. 4:2       Identifies own learning need by seeking assistance from the department supervisor         and/or director. 4:3       Participates in own performance appraisal by identifying own individual goals and           reviewing progress with department supervisor. 4:4       Participates in departmental/professional organization meetings as indicated by   attendance records. 4:5       Provides reports as requested, to administration, and appropriate committee(s) in a        timely manner. 4:6       Attends committee meetings as assigned. 4:7       Communicates departmental/community problems to administration. 4:8       Works closely with other hospital staff and department managers to identify ways to      improve the delivery of patient care. 5.         Supervises the Resource Managers, overseeing the daily operations of the department to ensure the quality of work. 5:1       Monitors job performance of each employee as indicated by quality of work      maintained and performance appraisals being completed. 5:2       Ensures that staff supports and adheres to the philosophy and standards of the   hospital. 5:3       Communicates with physicians, co-workers, staff and other departments to ensure         that the needs of the patient are met in a timely manner, through positive interaction    demonstrating dignity and respect. . 5:4       Supervises employee in such a manner as to promote teamwork and demonstrate          how each department or unit fits into overall hospital services. 5:5       Maintains adequate staffing to allow for optimum functioning of the department. 6.         Adheres to and follows the principles of Fishermen’s Hospital’s Quality Customer Relation Program. 6:1       Promotes quality customer relations by identifying both internal and external       customers; acknowledging customers promptly; and using expressions that express             respect, understanding, and enhance self esteem. 6:2       Creates a positive impression through effective use of telephone skills such as     answering the phone by the third ring, identification of self and department,   listening attentively, personalizing the conversation, and verifying information. 6:3       Creates a supportive climate for customers by allowing customers to express     themselves, addressing their concerns as being real and encouraging two-way           communication. 6:4       Promotes therapeutic interaction with customers by identifying behaviors resulting           from dissatisfaction; then, allowing customers to respond openly, showing empathy   and discussing options. 7.         Responsible for copying and submission of charts requested by CMS for validation purposes in a timely manner. 7:1       Serves as a liaison between hospital administration, Resource Management, physicians, and staff in meeting criteria of care for core measures patients as mandated by CMS and JCAHO standards. 7:2       Oversees and assists with abstraction of data on core measures patients on a     quarterly basis. QUALIFICATIONS: Education: An Associate\'s Degree in Nursing is preferred with a current Florida RN license. Experience:  Three years med./surg. clinical experience, prior managerial experience is required. Prior Resource Management experience is preferred. Management Experience Required: Excellent human relations and oral/written communication skills. Proven managerial skills. Ability to prioritize activities and plan work effectively. Capable of functioning in a stressful environment with appropriate interpersonal and counseling skills. Problem solving/decision making abilities.