Job Description

• The System Director of Case Management is responsible for the overall development of the case management program.
• This position oversees the delivery of case management services within the Los Angeles service area, ensuring that patients receive coordinated, high-quality care that meets clinical, operational, and regulatory standards.
• This role supervises a team of case management directors, managers, and supervisors in the four hospitals.
• This position has oversight of all case management staff, development and implementation of case management policies and procedures, and coordination of care with other healthcare providers and community resources.
• The System Director is also responsible for ensuring that all case management metrics, KPI’s, initiatives, are on track and meeting goals and objectives.
• Maintains compliance with all applicable regulations.
• Actively and consistently contributes to department operations and communications, behaves in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) in patient communication.

Essential Functions:

• Oversee and direct the operations of the hospital case management departments at Pipeline Health.
• Evaluate and develop a case management program at Pipeline utilizing a system approach
• Oversee leadership staff in the case management department, including hiring, training, performance management, and disciplinary action, ensuring optimal provision of services through sound personnel management.
• Assure alignment with case management overall strategic goals and objectives
• Ensure compliance with federal, state and local regulations pertaining to case management
• Drive LOS initiatives with hospital case management leadership, physician advisor and nursing leadership
• Lead denial management strategies with Revenue Cycle Team
• Assist the case management leaders with training and development of all case management staff including nurses new to the profession
• Continued assessment with case management leadership of staffing needs, ensuring stabilization of the hospital departments
• Development and implement case management policies and procedures, ensuring that they are aligned with best practices and applicable regulations.
• Provides comprehensive reporting to corporate and hospital executives and other stakeholders to include KPI’s, avoidable delays, LOS and other metrics as determined
• Build trust and confidence with physicians and hospital executives ensuring solid collaborative relationships.
• With the hospital case management leadership maintain case management department performance improvement and quality plans
• Maintain current competencies and updated knowledge in the specific area of practice.
• Effectively manage financial resources within the areas of responsibility, including labor management, productivity, observation management, avoidable days and overall LOS.
• Collaborate with UM physician chairs to develop and participate in scheduled UM Committees
• Build relationships with community partners
• Act as a clinical resource for the Hub when needed
• Participate in all payor JOMs
• Uses clear, concise, professional communication with coworkers, patients, all customers internal and external.
• Uses AIDET in interactions with patients and family members.
• Acts with a sense of urgency when performing tasks.
• Basic unit/department maintenance such as keeping files, drawers, cabinets free from unnecessary clutter.
• Reports on any equipment and or environmental issues for repair.
• Abides by HIPAA (Health Insurance Portability and Accountability Act) regulations.
• Speaks up to stop the line and escalates potential safety events if necessary.
• Completes and attends monthly training assigned.
• Other duties as assigned.

Behavioral Standards:

• Demonstrate behaviors commensurate with the vision, mission, values, and behavioral standards of the organization.
• Serve as a role model for the mission, vision, and values of the organization and fulfill other job duties as requested within the scope of practice.
• Serve as a role model and mentor for staff and peers.
• Treats everyone as their customer; utilizes scripting and other tools to ensure consistency in customer service; Expresses recognition and shows appreciation to others; fully utilizes AIDET principles; responds quickly to handle requests, complaints, and questions; displays a positive attitude.
• Demonstrates the highest level of professionalism, passion and care when interacting with patients, families, physicians, and hospital staff members.
• Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential, embracing ingenuity to service our customers.

Communication/Knowledge:

• Wears nametag properly; follows dress code policy; answers phone correctly and promptly; is prepared for meetings; meets deadlines; does not participate in gossip; acts ethically and treats others with respect; respects customer’s and co-worker’s time; establishes and maintains effective relationships with customers and co-workers.

Collaboration/Teamwork:

• Holds staff meetings; follows HIPAA guidelines; follows patient rights policy; complies with the compliance program; demonstrates knowledge of role in a disaster; demonstrates knowledge of fire and fire drill procedures; working knowledge of hospital emergency codes; always utilizes standard precautions in the clinical setting; safely manages the environment of care by demonstrating a working knowledge of the requirements of the: Life Safety program, Utilities Management program, Hazardous Materials program, Emergency Preparedness program, Safety Management program, Medical Equipment Management program, Security Management program.

Qualifications/Experience:

• Minimum of five (5) years’ experience in Clinical Nursing, required.
• Minimum of five (5) years’ experience in case management, preferably in a hospital setting.
• Minimum of three (3) years’ experience in a supervisory capacity or higher, required.
• Critical thinking, service excellence and good interpersonal communication skills, ability to read/comprehend written instructions, strong organizational skills, ability to follow verbal instructions, and PC (computer) skills.
• A capacity to learn, synthesize, make critical judgments, work independently, place patients and families first, and collaborate with the team members who are recognized leaders within health care.