<p>Director</p> <p>Case Management</p> <p>Licking Memorial Health Systems (LMHS) is a leading, non-profit healthcare organization, passionately dedicated to improving the health and well-being of our community. With a history dating back to 1898, LMHS remains a cornerstone of healthcare excellence, catering to the evolving needs of Licking County. Our cutting-edge facility provides a comprehensive spectrum of patient care services, from life-saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness.</p> <p>When you join the LMHS team, you become a vital part of your local community Hospital. Working at LMHS is not just a job, it is a unique opportunity to directly impact the health and well-being of your friends, family, and neighbors. You will be providing care in a place in which you are personally connected, where the impact of your work extends beyond the Hospital doors and into the heart of our community. Our commitment to diversity, equity, and inclusion ensures that every member of our community is served with respect and compassion. Join us in our mission - dedicated to patient safety, utilizing state-of-the-art technology, and with a passionate team of highly trained and compassionate individuals who strive to improve the health of the community.</p> <p>Position Summary</p> <p>Serves as the department director for the Inpatient Case Management Department. Responsible for case management, utilization review, discharge planning, social services, and dietitians. The director is responsible for planning, organizing, and overseeing all department functions. Manages relationships with payers, physicians, hospital referral sources, and case management staff.</p> <p>Responsibilities</p> <ul> <li>Perform strategic planning activities and daily management of operations </li><li>Ensure timely and effective transitions of patients, including discharge planning and coordination of care with other healthcare providers </li><li>Identify areas for improvement in case management processes, develop new workflows, and implement changes to improve efficiency and patient outcomes </li><li>Maintain strong communication with physicians, nurses, and other healthcare professionals, as well as insurance companies to ensure seamless care coordination </li><li>Initiate and engage in process improvement activities </li><li>Maintain compliance with relevant regulations and accreditation standards, including any updates or changes that may directly impact services provided by case management such as discharge planning, identifying and reducing hospital readmissions, promotion of effective utilization of services and reimbursement for care provided </li><li>Oversee medical necessity utilization review, appeals and denials management related to medical necessity audit activities (RAC, MAC, commercial payer denials, internal reviews/audits, etc.) </li><li>Train and motivate case management staff to accomplish department goals and objectives </li><li>Develop and oversee the annual case management budget </li><li>Prepare and evaluate reports on the department's activities </li><li>Develop and update policy and procedures for case management operations, ensuring adherence to organizational standards and best practices </li><li>Lead utilization review committee meeting, providing meaningful information and suggestions for improvements </li></ul> <p>Requirements</p> <ul> <li>Registered Nurse RN State of Ohio with a Master's Degree preferred </li><li>Case Management Certification preferred </li><li>3-5 years hospital experience </li><li>Familiar with nationally recognized utilization review criteria (InterQual, MCG) </li><li>Familiar with Medicare and Medicaid rules and regulations relating to hospital admissions </li><li>Excellent communication, interpersonal, and conflict resolution skills are essential for interacting with patients, families, and other healthcare professionals </li><li>Ability to analyze data, identify trends, and develop solutions to address challenges in care transitions </li><li>Computer Skills </li><li>LMH is accredited by DNV and TJC, and as such, may require specific annual education related to specialty certifications and standards. </li></ul> <p>Licking Memorial Health Systems is an equal opportunity employer and maintains compliance with all state, federal, and local regulations. Licking Memorial Health Systems does not discriminate against applicants because of race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors protected by law.</p>