This position will strengthen the CM Department and facility-wide case management efforts by accessing data from both internal and external sites; will develop and prepare reports utilizing the information gained from the analysis. The position will also be able to collaborate with all departments to ascertain CM data needs to include:
· The Hospital leadership must have data available to quickly assess CM functions/performance and track progress with reports or scorecards/dashboards.
· The director of CM who is responsible for monitoring all CM initiatives and guiding ongoing departmental projects must be able to have access to and present data in useful format to the Utilization Management Committee (UMC) and other committees as requested/required.
· Data will be collected on physicians, who will be provided an objective picture of comparable individual and peer outcomes.
· This position will utilize currently available systems and data sources: McKesson Interqual, AS400, Cerner, and will communicate, monitor and analyze data for/with the upcoming EHR contract.
· This position will require familiarity with electronic medical records, regulatory requirements’ pertaining to CM services, CMS Conditions of Participation (COP’s), Joint Commission Standards, and Case Management Society of America (CMSA) standards of Practice.
· Other data maybe assigned such as daily, weekly and monthly statistics to include: Avoidable Days (AD’s) with letters of explanation to responsible parties, length of stay (LOS) by physician and payer, Observation Status, One Day Stays. Medical necessity data on admission, continued stay and discharge. This description is not intended to be a complete list of duties, other duties may be assigned: typing appeal and denial letters to third party payers and Insurance companies, take formal minutes at the Utilization Management Committee and assist the director of CM as needed.
• High School diploma or equivalent. BS/BA Degree Preferred
• Current American Heart – HeartSaver or Basic Life Support (BLS) card.
• Three or more years work experience in a clinical environment.
• Performs related responsibilities as assigned.