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Leads and oversees the hospital's risk management (RM) program. Coordinates insurance coverage and risk financing, manages professional and general liability claims against the hospital, and supervises the daily activities of the RM Department. Ensures the facility complies with all applicable regulatory standards while striving to enhance patient safety and quality care and to minimize loss.: Designs and implements risk management surveys and studies; conducts surveys and special projects to assist in long-term planning and changes to facility policies and systems that reduce risk and losses. Identifies and communicates regulatory requirements to senior management. Plans, develops, and implements risk management educational programs for administration, board members, the medical staff, and associates. Answers medical and legal inquiries from Physicians, Nurses, and Administrators regarding emergent issues. Participates with the Ethics Committee to resolve patient care issues. Collects and analyzes data. Utilizes clinical information systems, including quantitative analysis tools, benchmarking tools, and computer applications. Reports on a regular basis to the Board Quality and Performance Improvement Committee and other committees as requested. Develops annual budgets for risk/ insurance cost centers. Identifies and explains variances from budget.

Case Management Manager

Oversees utilization management, care coordination, and discharge planning for patients. Assesses, plans, implements, monitors, and evaluates the services and options available to meet individuals' health needs, using screening criteria, developed critical pathways, and available resources to promote quality cost effective care outcomes. Supports the physician and interdisciplinary team in facilitating patient care in order to enhance the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. Identifies areas where performance improvement is needed, such as daily workflow, education, process improvements, and patient satisfaction.: Contributes to profitability and growth through expansion activities in case management (CM) care management. Assists in the development strategy with implementation of strategic, high quality, CM care management customer-specific products. Assists in the development of short- and long-term case management strategies, objectives, and budgets. Serves as resource for other departments in solving problems relating to patients, physicians, providers, payers, vendors, and accounts. Assists in development of and implements departmental and company policies and procedures. Conducts analysis of quality and productivity auditing of staff and departmental workflows. Directly manages licensed staff in CM Department, including interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; and addressing complaints and resolving problems. Assists the Director in the development and management of the CM Department budget, including monitoring overtime and associated costs, submitting purchase orders for departmental supplies, recommending additional staff, and assisting with purchases and capital expenditures requiring higher level authorization.

Case Management Supervisor

Supervises the daily operations of the case management function. Communicates with departmental and plan administrative staff to facilitate daily department functions. Assists with the implementation of policies and procedures regarding medical case management. : Facilitates the planning, monitoring, and implementation of care for patients. Coordinates case management activities with medical staff, data informatics, quality and utilization departments, etc. Evaluates patient outcomes and revises treatment plans as needed. Authorizes ancillary services, as needed, after approval by Physician. Ensures that client individual program plans comply and are consistent with client needs, laws, Federal and State regulations, contractual agreements, emergency management policies, and established referral, pre-certification, and authorization policies and procedures. Organizes and supervises liaison activities with community programs. Facilitates ongoing communication between case management staff, utilization management staff, and contracted providers. Acts as medical resource for appeals function. Conducts reviews of cases with doctors, hospitals, and other providers. Identifies trends and assists in financial forecasting. Trains, mentors, supervises, and evaluates case management staff.

RN Field Case Manager

Provides ongoing evaluation and nursing case management services, meeting with clients in their homes, work-sites, or physician's or therapist's office. Assesses, evaluates, and analyzes injured workers’ medical and/or vocational status, and develops, coordinates, and implements a viable, realistic service plan. Monitors the progress of the injured/disabled individuals and reports results back to the employer and insurance carrier.: Develops a plan of care for patients from admission to discharge. Monitors individuals’ progress toward desired outcomes through assessments and evaluations. Communicates both in-person and by phone with client, medical providers, attorneys, employers, employees, insurance carriers, etc. Develops and administers education and prevention programs. Develops guidelines for working with patients, healthcare management companies, insurance companies, or other third party payers to determine quality, cost-effective care. Applies all special instructions required by individual insurance carriers and referral sources. Applies all laws and regulations that apply to the provision of rehabilitation services. Testifies when called upon to do so, to substantiate any casework or reports that may be seen as relevant to hearing involving client. Evaluates outcome of patient care. Prepares reports and other required paperwork as documentation of all casework activities. May arrange referrals, consultations, therapeutic services, and confers with other specialists on course of care and treatment.

Medicare Nurse Case Manager

Plans, directs, implements, and evaluates appropriate healthcare services for Medicare patients in conjunction with Physician's treatment plan to ensure that cost effective, quality care is provided. Typically requires licensure as a Registered Nurse with three years of relevant nursing and medical case management experience. Certification as a Case Manager or professional certification in a clinical specialty may also be required.: Coordinates cases that normally include prospective and retrospective review and prior authorization, determining the appropriate level of care and utilization of services, concurrent review, retrospective review, developing discharge plans, and ensuring quality cost effectiveness. Develops a plan of care for Medicare patients from admission to discharge. Monitors patient progress toward desired outcomes through assessments and evaluations. Develops and administers education and prevention programs for Medicare patients. Analyzes referred cases for potential case management interventions. Evaluates the effectiveness of alternate care services and ensures that cost effective, quality care is maintained to meet case management objectives. Determines if proposed medical treatment plans meet contract provisions. May arrange referrals, consultations, therapeutic services, and confer with other specialists on course of care and treatment. May negotiate fees with providers of medical care, agencies, and outside vendors to achieve maximum cost effectiveness.

Nurse Case Manager (Mentor)

Plans, directs, implements and evaluates appropriate healthcare services in conjunction with the physician treatment plan to ensure that cost effective, quality care is provided.: Case coordination normally includes prospective and retrospective review which includes prior authorization, determining the appropriate level of care and utilization of services, concurrent review, retrospective review, developing discharge plans, and ensuring quality cost effectiveness. Develops a plan of care for patients from admission to discharge. Monitors patient progress toward desired outcomes through assessments and evaluations. Develops and administers education and prevention programs. Analyzes referred cases for potential case management interventions. Evaluates the effectiveness of alternate care services and ensures that cost effective, quality care is maintained to meet case management objectives. Determines if proposed medical treatment plans meet contract provisions. Authorizes initiation of medical case management. This position typically requires a licensed Registered Nurse with a minimum of five years of relevant nursing and medical case management experience. Certification as a case manager or professional certification in a clinical specialty may also be required. May arrange referrals, consultations, therapeutic services, and confer with other specialist on course of care and treatment. May negotiate fees with providers of medical care, agencies and outside vendors to achieve maximum cost effectiveness. May provide guidance to less experienced case managers.

Disease Case Manager

Provides intensive, comprehensive case management in a multidisciplinary medical environment, using in-depth clinical knowledge of disease conditions and pharmacological agents, and increases efficient utilization of services for members with a specific diagnosis. Identifies, educates, assists, and manages the health plan patient of various client groups including commercial accounts, Medicare, and Medicaid participants. Develops, implements, and maintains a disease management program for enrollees with a specific diagnosis to include asthma, diabetes, sickle cell, HIV, and high-risk maternity. Typically requires licensure as a Registered Nurse or Registered Respiratory Therapist (depending upon targeted area of assignment) with a minimum of three years of clinical experience working with individuals in ambulatory, acute, or home care settings.: Clinically assesses, identifies, coordinates, educates, and manages members with various disease states while working cooperatively and effectively with the preferred care delivery system to assure high quality, cost effective care for members. Identifies, educates, assists, and manages the health plan patient to promote the best quality of life for the enrollee and control costs associated with healthcare delivery. Develops and implements services that support the disease management program. Performs in-depth screening of enrollees for disease and/or case management eligibility, using predetermined criteria as outlined in the disease case management program. Designs an individual treatment plan in conjunction with Physician for overall care of enrollees. Monitors enrollee's condition on an ongoing basis by means of regular telephone calls and on-site visits. Follows up with inpatients during and after hospitalization. Evaluates enrollee's response to treatment and updates treatment plans as necessary. Maintains ongoing communication with Physician and health plan providers regarding enrollee's condition and response to care.

Case Supervisor

Supervises and coordinates activities of social-service-agency staff and volunteers, and students of school of social work: assigns caseloads and related duties, and coordinates activities of staff in providing counseling services to assist clients with problems of emergency or crisis nature. Assists agency staff members through individual and group conferences in analyzing case problems and in improving their diagnostic and helping skills. Reviews case records and evaluates performance of staff members and recommends indicated action. Participates in developing and implementing agency administrative policy. Counsels clients individually or in groups on planned or experimental basis and in emergencies. Trains new employees in areas such as agency policy, department procedures, and agency or government regulations. Provides in-service training for experienced workers in areas such as new policies, procedures, and regulations. Represents agency in community or in interagency activities. May conduct or direct staff development programs. May train workers is use of computer. Employed in areas such as child welfare, community welfare councils, family casework, youth services, senior citizen services, health services, public welfare, probation and parole, housing relocation, education, and rehabilitation. Usually required to have master's degree from school of social work.

Case Packer & Sealer

Tends machine that packs and seals cartons of cigarettes in shipping cases: starts machine and conveyor belt and observes flow of cartons on conveyor to determine whether cartons are filled and sealed according to specifications and that date stamp is legible. Removes defective cartons. Shapes collapsible cases and places open end of case over mouthpiece of packing unit, or loads blank shipping cases onto feed magazine. May adjust counting and weighing mechanism on packing machine.

Case Management Head

Directs and coordinates case management to assure quality cost effectiveness of high risk and high cost cases. : Develops guidelines for working with patients, health care management companies, insurance companies or other third party payers to determine quality cost effective care. Case coordination may include prospective and retrospective review that includes, but is not limited to, prior authorization, determining the appropriate level of care and utilization of services, concurrent review, retrospective review, developing discharge plans, and ensuring quality cost effectiveness. Evaluates outcome of patient care. May arrange referrals, consultations, therapeutic services, and confer with other specialists on course of care and treatment.

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