Health Equity Manager-case Management - Greenport, United States - Stony Brook Southampton Hospital

Description

• The Case Management (CM)/Health Equity Manager (HEM) will be responsible for the overall administration and operation of health equity and the case management department. The CM/HEM is responsible for the development, implementation, and evaluation of systems and processes related to health equity and case management, inclusive of utilization management. They will work collaboratively with the Social Work department in developing an organization wide health equity program, with the goal of meeting and sustaining the requirements for Joint Commission advanced certification. The CM/HEM is responsible for ensuring the department provides high quality, fiscally responsible and cost effective services that are responsive to the needs of the patients, families, and other members of the healthcare team. The CM/HEM is a member of the management team and reports directly to the VP for Quality and Regulatory Affairs.
• The CM/HEM will report to the VP for Quality and Regulatory Affairs and will work closely with the AVP for Quality.

• Provide leadership in the development, implementation, and oversight for all aspects of case management to support patient centered care.
• Oversight for the daily operations of the case management department to ensure quality patient care.
• Direct the development and implementation of standards, systems, policies, and procedures in alignment with organizational strategic initiatives focused on quality and financial outcomes.
• Ensure efficient resource utilization, quality outcomes, and maximization of reimbursement.
• Collaborates with others in the organization to optimize compliance with regulatory and payer requirements and to promote the delivery of high quality, efficient, costeffective, and appropriate care
• Collaborates with the Business Office, other departments and insurance companies to ensure appropriate reimbursement
• Ensures compliance with federal and state regulations, as well as established organizational policies and procedures
• Develops analyses and reports of various activities to determine department progress toward stated goals and objectives
• Provides oversight for medical necessity reviews, denials management, and utilization management supporting all areas of the organization
• Fosters integration and strong clinical partnerships with hospitalists, physician advisors, and clinical integration activities in order to optimize care coordination, ensure efficient resource utilization, improve quality outcomes and enhance patient satisfaction
• Maintains effective communication and a strong managerial presence with executive leadership, senior leaders, and internal and external organizations to coordinate and adequately address patient care needs.
• Prepares, analyzes, and presents reports and recommendations to senior leadership regarding operations and/or other applicable areas of interest in order to provide concise and accurate information that aids in decisionmaking. Develops, reviews, and monitors clinical, service and financial outcomes using performance metrics.
• Advocate for and foster positive relationships with patients, families, and other members of the healthcare team
• Serve as a resource to case managers regarding best practices and ethical decisionmaking.
• Monitor staff performance and provide feedback and coaching to promote professional growth.
• Collaborate with interdisciplinary team members to develop individualized treatment plans
• Conduct ongoing documentation audits to ensure compliance with regulatory metrics.
• Act as a liaison between the organization, the SBUH system and communitybased organizations
• Facilitate daily workflow to optimize the coordination of patient discharges.
• Maintain a current knowledge base in the field of case management and health equity to ensure the department is providing evidencebased care.
• In collaboration with Social Work and the healthcare system, coordinate, develop, implement and measure all aspects of health equity while moving toward advanced certification.
• Attend and actively participate in various committees within SBELIH and SBUH
• Manage special projects.
• Oversee patient experience for the transition of care/discharge domain.
• Acting discharge leader according to disaster plan

• Bachelor's degree in nursing
• PRI and SCREEN certification
• Minimum 7 years' experience in Case Management
• Experience in Med/Surg./ICU/ ED
• Excellent written and interpersonal communication
• Proficient in WORD, EXCEL, and MCG guidelines
• Knowledge of regulatory and accreditation requirements

• Leadership experience
• Experience in Health Equity