Job ID: 990197
Job Title: Director Case Management- SWMC
Location: Lawton, OK
Southwestern Medical Center- Director of Case Management
Hospital Website: https://swmconline.com/
Leadership Team: https://swmconline.com/our-leadership
Lawton, OK: https://www.lawtonok.gov/
Background
Our 199-bed hospital offers a full range of inpatient, outpatient, and emergency medicine services, including inpatient behavioral health services. Southwestern Medical Center is proud to be the first Joint Commission certified Primary Stroke Center in our region and the first rehabilitation facility to receive a three-year accreditation from CARF. Our team members are committed to following stringent patient safety and quality standards, making us a trusted source of high-quality care.
Southwestern Medical Center (SWC), in Lawton, Oklahoma, has been named an Oklahoma Top Workplace for 2019 by The Oklahoman. This marks the hospital’s seventh year in a row to be named to the list of Oklahoma Top Workplaces. The list is based on anonymous surveys of employees that measure several aspects of workplace culture. SWC was one of 90 organizations, one of only four hospitals and the only hospital in southwest Oklahoma to receive the recognition.
Duties and Responsibilities
•Oversight of the Facility’s Case Management team to ensure compliance with standards of practice and other regulatory requirements related to care management and utilization review.
•Develop and foster effective collaboration between Case Management Departments, Medical Staff, corporate and facility leaders to ensure an integrated approach to providing care while fulfilling the hospital’s goals and objectives.
•Display an ability to work effectively within the health system’s decision making and organizational structures.
•Work closely with providers as well as internal and external physician advisors for utilization review and management activities
•Coordinate all UM Committee activities to ensure compliance with meeting frequency and documentation of activity and outcomes
•Work collaboratively with Revenue Cycle teams and participates in task force meetings related to medical necessity audits and denials.
•Participate in appeals processes and work collaboratively with vendors to ensure the effectiveness and timeliness of appeals
•Analyze length of stay and readmissions data and incorporate measures with Operations team members, Corporate Case Management Directors, and other facility leaders to ensure goals are met
•Introduce evidenced based practices geared to improve case management and transitions
•Conduct regular staff meetings to review pertinent Federal and State regulatory requirements, emerging internal and external trends, and provide general training for staff
Education:
BSN preferred; Registered nurse is required. Certification in Case Management or Utilization Review is preferred.
Applicants with the following licensure may be considered: Oklahoma RN
Skills
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•Demonstrated leadership and complex organizational management skills •Excellent management, problem solving, team building & organizational skills •Familiarity with Federal & State regulations related to case management discharge planning. •Knowledge of integrated discharge planning practices and resources available to patients •Demonstrated knowledge of RACs, MACs and the Medicare appeals process •Ability to work with Administration, Physicians, and staff in multiple settings •Ability to compile reports and interpret data •Ability to prepare and administer presentations Ability to interpret and apply InterQual criteria |
Experience: A minimum of 5 years’ experience in case management, discharge planning, and/or utilization review in an inpatient acute care setting. Strong clinical background is preferred.
