Position Summary

MF 8:30AM 4:30PM with oncall rotation /weekend rotation

Assures the delivery of quality services in accordance with established hospital departmental and regulatory/accreditation agency standards.

Is responsible and accountable for the overall operations of their assigned department in conjunction with UM manager and the department Director. Overall operations of the department including quality assurance and PI plan development of department goals and objectives that are consistent with the hospital mission the management of personnel preparing/monitoring of and accountability for the department budgets.

Assures employee compliance with hospital nursing department and Human Resources policies and procedures

Assures that employee orientation skill competency and continuing education requirements are satisfied as per regulatory requirements government state hospital and department policies/regulations.

Participates in the hospital Performance Improvement Program as defined by the organization and sets up department PI plan based on regulatory requirement as needed. Follows up on outliers and areas identified as needed improvement.

Is responsible for participation on committees task forces and projects as appropriate and required.

Assures the provision of a safe employee/patient environment and follows up on all staff incidents and safety issues. Maintains knowledge and continuing education related to the operations and needs of the department.

Works collaboratively with all levels of the hospital interdisciplinary team and promotes the team concepts effective communication and cooperative spirit within the department and hospital wide departments.

Demonstrates positive customer service skills fosters positive employee relations and assures staff adherence to the Customer Service Behavioral Standards.

Is supportive of hospital initiatives and projects and functions. Serves as a role model and a positive change agent.

Promotes a positive and professional image and behaviors. Serves as a coach and mentor and provides necessary resources to staff peers and patients as needed.

Establishes and maintains good working relationships with community agencies and facilities. Develops ways of getting monthly information from them re stats and outcomes to ensure our patients are receiving the best possible care after transition and discharge.

Has a working knowledge of Medicare and Medicaid guidelines and regulatory requirements/parameters to ensure compliance. Has an understanding of HMOs operations and other private health insurances.

Essential Functions and Responsibilities Includes the Following:

1. Understands and adheres to the WPH Performance Standards Policies and Behaviors
2. Develops and submits departmental goals and objectives as required by the Division Administrator on an annual basis.
3. Interviews recommends hires evaluates counsels and recommends terminations of employees as per hospital policy and departmental needs.
4. Schedules staff based on budgeted staffing plan and hospital needs ensuring adequate coverage for a safe patient care to prevent delays in discharge.
5. Develops and submits operating and capital budgets and reports variances on a monthly basis as required by the department director.

1. Assures compliance with state regulations and accreditation standards.
2. Assures completion of staff orientation annual and ongoing competency and education requirements. Summarizes monthly PI studies done by the staff and recommends actions for improvement.
3. Attends and participates in continuing education programs and other related activities to maintain current level of skills and expertise to manage the department in conjunction with the UM manager and department director.
4. Participates and assures department involvement in ongoing Performance Improvement initiative. Submits monthly reports as required.
5. Attends Management/Leadership meetings as required.
6. Conducts staff meetings in the absence of the director to update staff and/or address department issues and ensures meeting minutes are being taken and kept for all staff and future reference.
7. Utilizes multiple methodologies to communicate information ensuring follow up and understanding of all levels of staff members.
8. Adheres to safety standards for employees and patients.
9. Participates in committees task forces projects etc. as required.
10. Performs all other related duties as assigned

Education & Experience Requirements

• Bachelors Degree in Nursing with RN License required Masters Degree in Nursing preferred
• 5 years managerial experience within the acute hospital
• Previous experience as a case manager required
• Knowledge of healthcare financial regulatory and payer issue setting required
• Knowledge of state local and federal programs required
• Experience with Millimen/Interqual criteria required
• PRI/Screen certification preferred
• C.C.M. certification preferred
• Computer skills required

Core Competencies

Demonstrates ability to establish twoway communication by clearly defining expectations and functions based on regulatory requirements and hospital policies.

Communicating with the staff utilizing a variety of methods and actively listening to ideas and concerns and responding in an appropriate manner.

Demonstrates ability to delegate responsibilities appropriately. Demonstrates ability to retain composure under stress.

Escalates issues to the director as soon as they occur to come up with joint resolutions for safe care and interventions.

Physical/Mental Demands/Requirements & Work Environment

• May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospitals SDS (Safety Data Sheet) data base and may be accessed through the hospitals Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the hospital switchboard saved on a disc
• Must be physically able to move quickly throughout the work environment and the hospital. Must be able to utilize a computer with Microsoft office experience. Must be able to read and write using analytical skills to interpret and data and make necessary conclusions and recommendations.
• Demonstrates ability to follow written and oral instructions required for the position.