Manager, Case Management & Social Work
Company: Houston Methodist
Location: Houston
Posted on: January 26, 2023
Job Description:
JOB SUMMARYAt Houston Methodist Willowbrook, the Manager Case
Mgmt & Social Services position is responsible for functional and
operational aspects of the Case Mgmt./Social Work department, an
integrated, interprofessional department which supports caregivers
to provide the highest quality, most clinically appropriate care to
patients and while promoting the most cost-effective utilization of
the hospital's resources. This position maintains accountability
for level of unit performance and results, possessing the ability
to interact with corporate and hospital administrators, medical
staff, and defined customers related to the Case Mgmt. system. The
Manager Case Mgmt./Social Work position is responsible for the Case
Mgmt. reporting system to ensure organization priorities are
appropriately addressed in all facilities.The manager position
responsibilities include managing the daily work activities of the
work unit/department staff, ensuring quality, productivity,
functional excellence and efficiency while assisting management in
accomplishing strategic and operational objectives. In addition,
this position provides guidance to staff and is responsible for
staffing, budget compliance, contributing to staffing decisions
such as hiring and terminating employment, coaching and counseling
employees on work related performance, and assisting in the
development and implementation of policies and procedures to ensure
a safe and effective work environment. This position also
implements training, monitoring and operations initiatives that
secure compliance with ethical and legal business practices and
accreditation/regulatory/ government regulations.PRIMARY JOB
RESPONSIBILITIESJob responsibilities labeled EF capture those
duties that are essential functions of the job.PEOPLE - 20%
- Performs management responsibilities of selection, scheduling,
supervision, retention, and evaluation of employees in the
department. Provides development and mentoring of staff. Meets or
exceeds threshold goal for department turnover. Develops direct
reports to perform these same functions. (EF)
- Provides fair and consistent leadership and communication to
maintain a competent and engaged employee group by conducting
regular department meetings to review policies and procedures and
operational matters, rounding on all employees, completing
performance appraisals, conducting new hire feedback sessions,
coaching/corrective counseling, and providing
recognition/commendations to achieve desired outcomes. Provides
timely guidance and feedback to help others strengthen specific
knowledge/skill areas needed to accomplish a task or solve a
problem. (EF)
- Facilitates and promotes effective team dynamics and
teambuilding strategies within and between departments;
participates and/or leads and facilitates department process
improvements as needed. (EF)
- Meets or exceeds threshold goal for department and/or system
metrics on employee engagement indicators. (EF)
- Provides leadership to ensure operational effectiveness and
efficiency of admission, concurrent and retrospective utilization
management and medical claims functions to meet and exceed
service-level goals and contract requirements. (EF)SERVICE -
20%
- Plans and organizes day-to-day department operations, schedule
and activities. Sets priorities and functional standards, giving
direction to staff as necessary to ensure the best possible
delivery of service and high customer/patient satisfaction.
(EF)
- Drives department service standards and activities to impact
department and/or system score for patient/customer-based
satisfaction, through role modeling and fostering accountability.
Serves and actively participates on various entity committees as a
voice for the department. (EF)
- Makes and executes decisions within delegated authority.
Escalates issues to management for resolution as appropriate.
Participates in resolving issues outside delegated scope of
authority. (EF)
- Maintains ongoing interactions with physicians and staff on how
to improve patient care and service provided. Manages
administrative issues effectively and timely, as well as, informs
and provides pertinent information to physicians.
(EF)QUALITY/SAFETY - 30%
- Ensures a safe and effective working environment; monitors
and/or revises the department safety plan and/or any specific
accreditation/regulatory required safety guidelines, including
infection control principles. Monitors and confirms staff maintain
their required credentials that demonstrate competency per
accrediting agency or department guidelines as applicable.
(EF)
- Uses and optimizes information systems to enhance operations;
supports entity-specific performance improvement and data
management/analysis functions. (EF)
- Employs a proactive approach in the optimization of safe
outcomes by monitoring and improving the department workflow, using
peer-to-peer accountability, reporting accidents, near misses,
and/or adverse events immediately per department protocol and
identifying solutions via collaboration. Adopts LEAN principles in
driving process improvements. Role models situational awareness,
using teachable moments to improve safety. (EF)
- Monitors self and employee compliance with policies,
procedures, and System HR Standards of Practice and performs
associated actions upon non-compliance (i.e., focal point review
requirements, disaster plan, inservices, influenza immunization,
wage and hour, standard hours, timely termination submission,
timely timecard approval, etc.). (EF)
- Supports maximization of Case Mgmt. system utilization,
including length of stay (LOS), readmissions, and other KPIs as set
by the organization. Strategizes and negotiates with the
interprofessional team, patient and family, providers and payors
about the care provided and the best course of action. Promotes
self-care activities, autonomous decision making, active patient
and family participation in treatment/care planning and health
promotion. (EF)
- Generates reports to identify trends and opportunities for
process improvement. Develops audit reports to identify quality
issues and areas for enhanced staff training. Evaluates department
procedures and operations as they relate to care coordination and
recommends changes to improve efficiency and effectiveness as
appropriate. (EF)
- Oversees the quality assurance and quality improvement
processes related to admission, concurrent and retrospective UM and
medical claims programs. Collaborates with medical and clinical
leadership to implement new processes for enhancing service levels.
(EF)
- Proactively identifies case management and/or social work
interventions and implements role descriptions and priority
expectations to improve care coordination metrics (LOS reduction,
discharges before 11am, readmission reduction, and other KPIs.).
(EF)FINANCE - 20%
- Assists in the development of department budget and ensures
that the department operates in a cost effective manner.
Manages/audits department expenses within approved budget
parameters, ensuring that the department meets the budgeted/flex
revenue and/or expense targets on a monthly and annual basis.
Develops staffing plans and schedules to meet department/patient
needs that reflect understanding of the importance of
cost-effectiveness. (EF)
- Implements department strategies to achieve financial target
and staffing needs, developing others to do the same, through
optimizing productivity, supply/resource efficiency, minimizing
incidental overtime and overtime percentage, and other areas
according to department specifications. (EF)
- Manages utilization management (UM) programs including Medical
Claims Review, Precertification and Reconsiderations and Appeals.
Collaborates with the Director of Case Management/Social Svcs on
criteria and policy and procedure development. Collaborates with
Physician and Nursing leaders and external entities to develop,
implement and evaluate UM programs and policies as directed and
ensures UM programs are consistent with national accreditation
guidelines. (EF)GROWTH/INNOVATION - 10%
- Identifies and implements innovative solutions for practice or
workflow changes to improve department operations or other
department-specific measures by leading unit projects and/or other
department/system directed/shared governance activities. Supports
change initiatives, maintaining effectiveness when experiencing
major changes in work responsibilities or environment; adjusts
effectively to work within new work structures, processes,
requirements or cultures. (EF)
- Proactively evaluates processes; recommends and implements
action plan(s) for change; follows through to ensure effective,
sustainable change. Participates in the development and
implementation of new procedures and the review and revision of
existing procedures. (EF)
- Identifies opportunities and takes action to build strategic
relationships between one's area and other areas, teams,
departments, and units to achieve business goals. (EF)
- Seeks opportunities to identify developmental needs of self and
staff and takes appropriate action. Ensures own career discussions
occur with appropriate management. Completes and updates My
Development Plan (MDP) on an on-going basis. Conducts conversations
with staff on their development. (EF)
- Recommends appropriate uses for the Case Management system,
coordinating initial training for new users and ongoing training
department staff of system upgrades, changes, and new functions as
necessary. (EF)This job description is not intended to be all
inclusive; the employee will also perform other reasonably related
business/job duties as assigned. Houston Methodist reserves the
right to revise job duties and responsibilities as the need
arises.EDUCATION REQUIREMENTSo Bachelor's Degree in Nursing or
Master's Degree in Social Work (MSW)o Master's Degree in Nursing
preferredEXPERIENCE REQUIREMENTSo Five years experience in
inpatient case management, social work or utilization management or
in the managed care/payer environment, of which one year must have
been in a people management role in healthcare; for HM candidates,
four years experiencein case management or social work, which
includes HM performance that demonstrates progressive leadership
abilities
Keywords: Houston Methodist, Houston , Manager, Case Management & Social Work, Executive , Houston, Texas
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