The Director of Case Administration is liable for improvement, coordination, communication and schooling of the Case Administration division, physicians and nursing in modalities to guarantee top quality value efficient care, whereas attaining excessive affected person and doctor satisfaction.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
1. Conforms to the established Requirements of Conduct
2. Answerable for the coordination and course of the case managers, coding employees together with the coder for the Emergency room and the documentation specialists. To guarantee environment friendly operations, accuracy in coding whereas speaking with the medical employees in insure an correct evaluation of the severity of the sickness of the affected person, report the complexity of the providers offered, scale back non-compliance danger, on the similar time encouraging employees participation in shaping the imaginative and prescient and values of Westlake Hospital.
three. Along side the Emergency Division Course insure that the cost grasp is updated and capturing all eligible charged to scale back non-compliance.
four. Develop a coordinated case management program integrating all applicable disciplines to guarantee sufferers are receiving top quality value efficient care. Proceed to develop the case management workforce because the panorama of the payers change.
5. Develop communication mechanisms between the hospital, physicians and payor to maximise reimbursement.
6. Develop employees to acknowledge and reply to the dynamic healthcare surroundings.
7. Develop and monitor working budgets,
eight. Develop and implement insurance policies and procedures as associated to present apply.
9. Combine disciplines in creating particular person plans of care.
10. Function a medical useful resource for case management points and supply schooling to hospital and medical employees relating to necessities for utilization and reimbursement.
11. Monitor and development patterns to determine applicable motion to enhance affected person effectivity.
12. Coordinate Utilization evaluation committee statistics and tasks, and supply info to committee and determine applicable steps to enhance affected person care or effectivity.
13. Function a member of the Income Cycle Committee to make sure correct coding and cost seize.
14. Talk with the Affected person Billing Division to make sure correct coding, certification knowledge is entered for claims processing
15. Develop a reporting mechanism to Affected person monetary providers a report of denials and appeals to insure we seize all income that isn’t accounted for.
16. Talk with ancillary departments to make sure fees are entered in a well timed method, in order that coding may be precisely entered inside the three-day requirement.
17. Monitor the interdisciplinary communication between case management, nursing employees and all ancillary departments.
18. Coordinated with the Director of Efficiency Enchancment all System extensive initiative similar to “Get with the Tips” insuring the implementation of the initiative is tough wired within the establishment.
19. Co-system manger of the MIDAS system, help in distribution of using all modules relevant to the software program.
20. Develop studies in MIDAS that may substitute logs and manuals manually stored by employees.
21. Help managers in analyzing knowledge from MIDAS to enhance efficiency of employees.
22. Function Chair Individual to at least one of the methods at Westlake Hospital to insure the ahead movement of that technique.
23. Different duties as assigned
JOB SPECIFICATIONS:
1. Abides by established HIPPA insurance policies and procedures to make sure all affected person relate info stays confidential.
2. Educated within the 9 Westlake requirements, in addition to the Vanguard Mission and Values and show the requirements and values of their day-to-day actions.
three. Enhances skilled progress and improvement by way of participation in instructional packages, present literature, in-service conferences and workshops.
four. Maintains established division/hospital/system insurance policies, procedures, directives, security, environmental andinfection management requirements applicable to this place
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