Primary Location:

Frazier Rehab Institute - UMC

Address:

220 Abraham Flexner Way Louisville, KY 40202

Shift:

Salary Shift (United States of America)

Job Description Summary:

UofL Health is a not-for-profit 501(c)(3) fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, more than 250 physician practice locations, and more than 1,200 providers in Louisville and the surrounding counties, including southern Indiana. 

With more than 14,000 team members – physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care.

Job Description:

The Care Management Supervisor is responsible for oversight and management of the rehab case management departments. The Supervisor promotes optimal patient outcomes in accordance with the policies, procedures, applicable laws and contracts, philosophy, mission, vision and values of UofL Health. The case management department drives of length of stay and readmission outcomes for the facility.  The case management supervisor works to ensure institutional compliance with regulatory agencies and third-party payers. 

The supervisor must demonstrate a working knowledge of finance, reimbursement, third party payers, community resources/agencies, accreditation standards, quality improvement, clinical care, and organizational issues. Utilizes the management process (plan, organize, direct and control) to provide a framework for decision-making.  Maintains confidentiality of information; actively supports organizational goals and objectives by providing needed information to divisions and departments. Must be able to adjust priorities quickly, organize multiple tasks simultaneously, and work interdependently with many levels of staff. Attention to detail; strong organizational, interpersonal and communication skills; and innovative problem-solving skills required. Must be able to adjust work hours depending upon departmental and organizational needs as determined by the director.

Essential Functions:

• Promotes the care management team’s use of clinical resources by conducting timely initial admission assessments based on clinical indicators and anticipated service needs; readmission risk assessments, timely referrals to ancillary & post-acute services, recommendations for appropriate level of hospital care, and validation of patient demographics and payor source.
• Assists with the development of policies and procedures to ensure departmental compliance with regulatory, ethical, legal, and accreditation standards, guidelines and regulations.
• Develop monitoring and tracking systems to improve data collection for the sole purpose of improving length of stay, readmissions, and use of hospital ancillary services in order to enhance reimbursement.
• Ensures the development and documentation of the multidisciplinary clinical assessment of patients on an on-going basis.
• Assists with the development of policies and procedures to ensures departmental compliance with regulatory, ethical, legal, and accreditation standards, guidelines and regulations.
• Evaluates technology, resources, and tools for application and use in daily operation and make recommendations which will improve our processes, systems, and revenue.
• Promotes education and involvement of staff; encourages certification.
• Demonstrates ability to motivate staff in a positive manner and to improve cohesiveness of the group.
• Participates in professional organizations; keeps abreast of changes in the field and pro-actively seeks to keep the hospital up to date.
• Represents the department in leadership activities as needed (committee work, JCAHO preparation, meetings, etc.); serves as a professional role model for others.
• Collaborates with clinical and financial staff to meet financial goals of the hospital.
• Aware of reimbursement changes, problems and patterns of reimbursement, taking action as needed to improve or resolve issues.
• Works with the director and staff to develop departmental goals to support the mission and direction of the hospital.
• Enhances professional growth and development through participation in educational programs, reading current literature, attending in-service meetings and workshops that are related to assigned areas of responsibility. Assumes responsibility of growth and development, maintains competency in care management principles.
• Committed to patient satisfaction and uses appropriate tools and services recovery to meet expected patient satisfactions metrics
• Actively involved to meet organization metrics and goals to ensure the financial security of the organization.
• Advocates for patient/family needs in a respectful, unbiased, and confidential manner.
• Educates physicians, patients and staff with regards to payors, financial issues, documentation, and potential compliance issues.
• Serves as a resource to physicians for clinical management and financial issues.  Assists the providers with promoting efficiencies in the care delivery system and reducing/ eliminating barriers to efficient/effective service.
• Possess strong problem-solving skills and takes initiative to so.  Works effectively with others.  Knowledgeable of the services lines and uses sound nursing judgement and adheres to the code of professional conduct.
• Promotes departmental goals of improved quality, improved patient outcome and conserving resources as evidenced by value enhancement activities. 
• Ensures compliance with rehab CARF accreditation standards.
• Maintains a case management caseload that fluctuates with volumes and needs of the department.

Other Functions:

• Knowledgeable of state laws, CMS conditions of participation, CARF standards, and TJC standards regarding regulatory requirements for care management and discharge planning and compliance with each.
• Maintain compliance with all company policies, procedures, and standards of conduct.
• Comply with HIPAA privacy and security requirements to always maintain confidentiality.
• Attend specialty service line case conferences and staff meetings.
• Maintains an active, unrestricted Kentucky Registered Nurse Licensure.
• Maintains current Basic Life Support-CPR.

Additional Job Description:

Education:

• Must have RN with a BSN. Master’s Degree in Nursing, Business, Health Care Administration or equivalent preferred. 

Experience:

• Two (2) years as Care Manager/Utilization Review Nurse
• Two (2) years rehab hospital experience (preferred)

Licensure:

• Unrestricted RN license in the state of Kentucky (required).

Certification:

• BLS-CPR (required)
• Case Management Certification (ACM, ANCC-Nurse Case Manager or CCM) (preferred)

Knowledge, Skills, and Abilities critical to this role:

• Therapy and Counseling: Knowledge of principles, methods, and procedures for diagnosis, treatment, and rehabilitation of physical and mental dysfunctions, and for career counseling and guidance. Knowledge of therapeutic interventions.

• Psychology: Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders.

• Knowledge of local and state policy related to scope of role
• Knowledge of community resources that will benefit hospital population

Language Ability:

•  Must be able to communicate effectively in both verbal and written formats.

Reasoning Ability: 

• Able to critically think through complex patient situations, process improvements, evidence-based practice.
• Able to assist others in developing clinical reasoning skills.

Computer Skills:

• Basic computer skills, including the use of electronic medical records (required)
• Knowledge of Microsoft Word, Excel, Outlook, Electronic Medical Record, Internet (required)

Additional Responsibilities:

• Demonstrate commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
• Maintain confidentiality and protect sensitive data at all times.
• Adhere to organizational and department specific safety standards and guidelines.
• Work collaboratively and supports efforts of team members.
• Demonstrate exceptional customer service and interact effectively with physicians, patients, residents, visitors, staff and the broader health care community.