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Manager, Clinical Resource Management

Post Date:
Service Area:
The HSC Pediatric Center
Status:
Full-time
Shift(s):
Days

Job Requirements

The Manager, Clinical Resource Management is responsibility for leadership and day-to-day operations of admissions, case management, social work, discharge planning, utilization review, interpreter services, chaplain program, and denial prevention & recovery at The HSC Pediatric Center.    

Essential job duties:  

1. Develops, recommends, and participates in the formulation of policies and procedures for assigned components of department and implements approved hospital policies 

2. Directs and manages day to day operations of specific components of the department 

3. Participates in the development of an annual plan for the activities of the department, including quality improvement, utilization review, clinical case management and discharge planning in accordance with regulatory agency requirements and the organization's strategic plan 

4. Coordinates the hospital’s utilization management committee and develops the corresponding utilization review plan 

5. Develops, implements and evaluates specified components of the department to ensure efficient utilization of resources 

6. Works with department staff to develop innovative programs and procedures for the most effective utilization of resources while maximizing revenue 

7. Participates in the development of an enterprise-wide care coordination plan to ensure a care continuum for patients and families in collaboration with other key departmental representatives 

8. Works collaboratively with the healthcare team to implement proactive discharge planning 

9. Leads interdisciplinary discharge planning rounds 

10. Identifies and makes recommendations to process improvement, performance improvement, and outcome measures for the facility 

11. Lends technical assistance to physicians and other professional staff in the identification of opportunities and development and implementation of best practices for clinical use 12. Develops a department dashboard with performance indicators for regular reporting 

13. Develops a comprehensive denial prevention and recovery program for inpatient and outpatient services, working with stakeholders and contracted revenue cycle staff 14. Manages, supervises and evaluates department staff   

Other job duties: 

1. May perform other duties in addition to those outlined in this job description.  

Required Knowledge, Skills and Abilities  

1. Thorough knowledge of best practices as it relates to utilization review, discharge planning, case management, social work, care coordination and denial prevention and recovery methodologies 

2. Thorough knowledge of the principles of health care administration; thorough knowledge of District and federal regulations and The Joint Commission regulations for hospitals and nursing homes. 

3. Thorough knowledge of hospital routines, organization and functions 

4. Thorough knowledge of the development, coordination, and delivery of medical services 

5. Thorough knowledge of the principles and practices of administrative supervision and decision making 

6. Thorough knowledge of hospital risk management issues 

7. Working knowledge of principles in developing clinical algorithms and clinical care pathways 

8. Demonstrated ability to monitor and conduct analyses of hospital operating procedures, identify problems and critical factors, and develop methods for corrective action 

9. Ability to develop and maintain effective working relationships with physicians, hospital managers, and other members of the interdisciplinary care team 

10. Ability to delegate responsibility and effectively 

11. Demonstrated above-average communication skills both orally and in writing 

12. Ability to organize, assemble, categorize and prepare data for reporting purpose 

13. Ability to plan and supervise the work of others 

14. Ability to effectively use computer applications such as spreadsheets, word processing, calendar, e-mail and database software; 

15. Working knowledge of clinical decision support tools such as Interqual or MCG 

16. Ability to read, write, speak, understand, and communicate in English sufficiently to perform the essential duties of the position 

17. Sound professional judgment; dependability; tact; discretion; integrity; resourcefulness; accuracy; initiative

QUALIFICATIONS

Required Experience:

Minimum of 5-7 years of progressive management experience in case management, UR and/or social work preferably in a health care setting  

License/Certifications:

RN, social work or similar clinical license in the District of Columbia; candidates without clinical licensure may be considered with significant, relevant experience   

Required Education:

Bachelor’s degree in health administration, social work, nursing, business administration or related discipline. MSN, MBA, MSW, MHA or similar relevant advanced degree preferred. Specialty certification preferred.

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English
Open-ended job posting
No
Contact Email
cmjohnson@cscn.org
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