Case Management Team Lead

Case Management Team Lead

Requirements

• Bachelor’s degree in Nursing
• Two years’ case management work experience required
• Licensure as a registered nurse by the state of South Carolina or compact state required
• Master’s Degree Preferred
• Case Management Society of America (CSMA) or American Case Management Association (ACMA) certification preferred
• Must obtain certification within 1 year, if not currently certified

Responsibilities

• Assist with coordinating the daily operation of the team to ensure the needs of the Service Lines and patients are being met
• Develop and maintain a work schedule for the CM Team ensuring adequate coverage
• Provide guidance, direction, and education to CM Team as needed to achieve department goals and hospital strategic initiatives
• Monitor LOS and readmission data and communicate findings to the CM Team
• Serve as a mentor to new employees and verify competencies
• Complete administrative duties as designated by the Director
• Function as a clinical expert and resource regarding resource utilization and case management
• Maintain expert level of knowledge of body systems and expected clinical outcomes for patient disease process to develop a plan of care and discharge plan for clinically complex patients
• Maintain current knowledge of changes in state and federal regulatory requirements related to the provision of case management services in a tertiary acute care setting
• Provide services in accordance with standards of practice as established by department and management
• Serve as a resource to the team, patient and family in the identification of health care resources
• Interact with organizational leaders to represent Case Management
• Develop partnerships with outside agencies to enhance the care continuum
• Participate in organizational initiatives which involve Case Management alongside other leaders
• Participate in hospital wide leader on-call and weekend coverage as defined by the Case Management Department
• Assist with coverage as needed
• Promote coordination of care to achieve successful clinical outcomes for patients
• Responsible for meeting the Case Management needs of a designated caseload of patients
• Participate in interdisciplinary team rounds and complex case rounds to identify patients in need of added support in discharge planning
• Identify and collaborate with care team regarding management of complex patients
• Assist with coordinating care to maintain continuity across a variety of patient care settings
• Negotiate approval of the plan of care with third party payers and external agencies as necessary
• Utilize and provide assistance to care team members using programs and department funds as appropriate to expedite discharge processes
• Evaluate plan of care outcomes based on LOS, readmission rates, and CMS data
• Initiate and develop process improvement processes as needed to achieve department goals in support of hospital strategic initiatives

Preferred Qualifications

• Master’s Degree Preferred
• Case Management Society of America (CSMA) or American Case Management Association (ACMA) certification preferred