The Director-Case Management is assigned supervisory responsibilities of the Case Managers, CDI personnel and operation of the department. Responsibilities include leading, supervising, and influencing the daily operational activities including preadmission review, Utilization review / resource management, social services and discharge planning. Supports the overall business plan by monitoring team performance and outcomes relative to established goals/measurements. Participates & Coordinates utilization functions to comply with hospital procedures and federal regulations; Maintains, disseminates, and acts on the federal and state regulations required for Medicare and Medicaid patients; performs case management analysis; monitoring activity processes, reporting & helping develop policies and procedures as directed. Communicates directly with physicians, as the liaison between payers and physicians to secure payment approvals/authorizations and to proactively prevent likely denial situations. Communicates effectively with other members of administration, medical staff and the interdisciplinary patient care team regarding service delivery, financial management, and discharge planning processes. Additionally, the Supervisor has his/her own case load, depending on staffing and current department needs, which includes: coordinates the delivery of care through assessment, planning, facilitation, and patient advocacy to ensure cost-effective, quality outcomes of care. Works with all members of the health care team to ensure optimal outcomes are reached while appropriate utilization occurs.
Minimum Requirements: Bachelor's degree, Case management experience, discharge planning, and/or utilization review in a hospital inpatient acute care unit, health plan or a combination of both. Current WA State RN licensure. Highly Preferred: Certification in Case Management or Utilization Review. Leadership experience and strong clinical background.
Internal Number: 14318
About Trios Health
Trios Health, formerly Kennewick General Hospital, is a multi-faceted public healthcare system located in southeastern Washington, primarily serving the Tri-Cities—Kennewick, Pasco, and Richland—and surrounding communities. What began as a small hometown hospital founded by a dedicated legion of Kennewick residents over 60 years ago has grown with the community that built it.
Today, Trios Health is anchored by its new Trios Southridge Hospital and remains deeply connected to its community roots, but with the ability to offer a lifetime of care across a broad spectrum of healthcare specialties and services. In fact, we've built what has become one of Eastern Washington's largest multi-specialty medical groups. And we've been careful to weave a strong thread of human compassion through the fabric of our culture. The result is an array of complementary inpatient and outpatient services—provided by passionate, empathetic people—that combine to provide holistic medical care for patients facing a variety of health challenges.
Your total health—mind, body, and spirit—is our priority. Continuing to evolve so that we're ready with the right healthcare services, available and accessibl...e when your life calls for them, is our commitment to you, the community we call home.
A little more about us:
•Our medical staff includes over 300 providers.
•We have multiple outpatient specialty Care Centers throughout Kennewick, including two urgent care locations and Kennewick's only after-hours pediatric service.
•The new state-of-the-art Trios Southridge Hospital opened in 2014 to accommodate the area's expanding healthcare needs.
•The Trios Foundation enhances patient care through fundraising that supports new programs, services, and equipment.