Director, Care Management
: Job Details :

Description:JOB PURPOSE:The Director Care Management is responsible for leading the hospitals Care Managementdepartment, defining and maintaining standards of practice for service delivery and organizationalperformance strategies consistent with PHCs Mission, Vision and Values, as well as those of theindividual hospital.KEY RESPONSIBILITIES:1. Provides performance improvement, operational, human resources and financial management ofthe Care Management department.2. Ensures that Care Management services, which include case management and social work, aredelivered in accordance with evidence-based guidelines, established standards of care practiceand performance, hospital policies and procedures.3. Pursue strategies and day-to-day operations that promote quality patient throughput in aresource/cost effective manner via effective care coordination and discharge planning.4. Ensures that department operations and delivery align with PHC and industry quality standards.5. Effectively promote Care Management practices as they relate to the use of software, e.g.,InterQual, and IT systems, leveraging for information / data collection, analysis and reporting.6. Monitor effectiveness by analyzing Average Length of Stay, Case Mix Index, avoidable days,denials, and other key metrics.7. Reports on regular basis with Chief Financial Officer regarding Care Management department.8. Implements and ensures collaborative working relationship with hospital and PHC leadership,the Utilization Management (UM) team and centralized functions, physicians, nursing, ancillaryservices and other key stakeholders.9. Works closely with UM leadership and Revenue Cycle to ensure issues are addressed in atimely matter, and that functions & processes align.10. Oversees monitoring of staff utilization based on workload, skill level, acuity and economicconstraints.11. Participates in Director and Leadership activities for hospital and PHC.12. Actively participates in strategic planning.13. Ensures a safe work environment for CM staff.14. Ensures appropriate training and resources are available to all staff within budgetary constraints,and promotes professional growth of all staff.15. Ensure that staff are consistently informed of departmental, hospital, PHC and general CMissues.16. Delegates responsibilities to appropriate personnel and ensures completion in a timely and effectivemanner.17. Notifies and consults with Risk Management as appropriate and per policy.18. Provides leadership in recruitment and retention activities; performs or participates in screening,interviewing and selection of employees.19. Implements Human Resources policies for performance plans, deployment, severance, outplacement,and other policies that support appropriate utilization of workforce resources.20. Ensure that personnel and competency files are maintained in accordance with hospital, PHC, TheJoint Commission and industry standards.21. Performs outreach activities with community based provider practices and agencies to promote carecoordination and support the CM departmental, hospital and PHC goals, as appropriate.Qualifications:MINIMUM EDUCATION REQUIRED:Graduate from an accredited school of nursing or Bachelors degree in Social Work, HealthcareAdministration or other related field.MINIMUM EXPERIENCE REQUIRED:Seven (7) years of case management or social work experience in an acute care setting, toinclude three (3) years of management experience in the acute setting.Comprehensive knowledge of the healthcare industry, care coordination, familiarity withgovernment regulations, healthcare plans and utilization management.Experience using InterQual or Milliman.MINIMUM LICENSURE / CERTIFICATION REQUIRED BY LAW:Licensure appropriate to the discipline.ADDITIONAL QUALIFICATIONS:Unrestricted registered nurse (RN) license, or eligible for RN licensure, in the state of Georgia or currentunrestricted licensed Master Social Worker (LMSW), or licensed Clinical Social Worker (LCSW) or eligiblefor licensure, in the state of Georgia required.Certification in Case or Care Management preferred.Additional certification or Masters degree in healthcare administration and / or finance preferred.