CASE MANAGEMENT – QUALITY & COMPLIANCE SPECIALIST

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Position’s Location: Lansing, MI

Job Description

General Purpose of Job:
Ensures that high quality case management services are achieved in collaboration with the multidisciplinary health teams.  The Quality & Compliance Coordinator supports and carries out the vision of the department; produces excellence; performs compliance activities; ensuring Case Management complies with state and federal regulations.

Essential Duties:
This job description is intended to cover the minimum essential duties assigned on a regular basis.  Caregivers may be asked to perform additional duties as assigned by their leader.  Leadership has the right to alter or modify the duties of the position.

  • Assists in compling operational metrics, to ensure a framework for optimal patient admission, length of hospital stay and discharge to accomplish a coordinated achievable discharge plan appropriate for the individual patient.
  • Ensures case management caregivers adhere to and understand Centers for Medicare & Medicaid (CMS) Conditions of Participation pertaining to discharge planning and third party payers.
  • Conducts audits and reviews to determine adherence to departmental policies, expectations, and requirements.
  • Assists in establishing and maintaining department policies and procedures related to Case Management.
  • Identifies opportunities for improvement and participates in department Performance Improvement, Corporate Compliance, Patient Satisfaction, Caregiver Engagement initiatives and monthly reporting of key operational information.
  • Maintains departmental resources and education for individual insurance company requirements for discharge planning, and prior authorization processes.
  • Assists in the development and achievement of department budget, goals and objectives.
  • Monitors customer satisfaction, performance improvement and corporate compliance indicators, and key indicators of effectiveness and efficiency to ensure optimal performance.
  • Assists in communicating shared vision, mission and values within departments, which motivates others to achieve strategic goals.
  • Performs other administrative duties as delegated by the director.

Job Requirements

General Requirements
  • Current Michigan Nursing License, or Michigan Licensed Master Social Work
  • CPHQ Certification or Certification in Case Management – preferred
Work Experience
  • Minimum of three years of experience in acute care case management
  • Previous experience with training or educational program development – preferred
Education
  • BSN or LMSW
Specialized Knowledge and Skills
  • Demonstrates ability to handle multiple tasks concurrently.
  • Proficient with Microsoft Outlook, Word with 80% passing score
  • Demonstrates ability to quickly adapt to change and work with ambiguous parameters.
  • Demonstrates ability to work independently, organize and prioritize work to meet all deadlines.
  • Demonstrates excellent verbal and written communication
  • Demonstrate ability to work in stressful situations, manage conflict and assume a leadership role.
  • Maintains an atmosphere that supports and encourages high performance, high levels of Caregiver engagement, teamwork, customer service, and continual improvement within a specific area of responsibility.
  • Strongly supports the direction of Sparrow and the members of the Sparrow team
  • Ability to utilize word processing, spreadsheets, presentation programs and Microsoft Office
  • Ability to work with a team
  • Strong analytical and statistical abilities
  • Demonstrated organizational and time-management skills
  • Strong attention to detail
  • Demonstrates ability to use a keyboard as may be required to perform the essential duties of the job.

Case Management Quality & Compliance

Sparrow Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.

To apply for this position, please copy and paste the following link into your browser address bar:
https://sparrowhealthsystem.contacthr.com/99220458