Director, Care Coordination
4 weeks ago
LOCATION: Columbia, Missouri
ABOUT THE JOB
Plan, organize and direct department responsible for care coordination/management operations, utilization review, social work, and resources management to achieve fiscal and clinical outcomes.
SALARY RANGE $110,260 to $179,795
ABOUT US
MU Health Care is a growing academic health system in mid-Missouri comprised of multiple hospitals - including the region's only Level 1 Trauma Center and region's only Children's Hospital - and over 50 specialty clinics located throughout the region.
As an MU Health Care employee, you will be part of an exceptional team committed to our mission of saving and improving lives and supporting our team members to achieve their personal and professional goals. Our core values of inclusion, respect, service, discovery, responsibility, and excellence foster a collaborative work environment where you can grow your career.
Learn more about MU Health Care. Learn more about living in Columbia, MO.
EMPLOYEE BENEFITS
* Health, vision, and dental insurance coverage starting day one
* Generous paid leave and paid time off, including 9 paid holidays
* Multiple retirement options, including 100% match up to 8% and full vesting in three years
* Tuition assistance for employees (75%) and immediate family members (50%)
* Discounts on cell phone plans, rental cars, gyms, hotels, and more.
* See a comprehensive list of benefits here.
ESSENTIAL FUNCTIONS
* Develop internal processes and identify process improvement needs. Serve as Clinical Liaison for managed care contracts and Medicare. Maintain utilization review/discharge planning functions in accordance with accreditation licensure process. Serve as off-site and on-site reviewer liaison. Maintain current knowledge of Medicare/Medicaid and other payor regulations/guidelines. Work with others in the management of denials from 3rd party payors.
* Develop, implement and continually improve processes for reducing and/or controlling length of stay, costs and/or resource consumption ensuing maintenance or improvements in patient outcomes; collaborate with others to design and implement processes that constantly improve coordination of care and effective care transitions.
* Establish and maintain collaborative working relationships with physicians and other hospital directors to support the mission, vision and values; work with clinical faculty to ensure coordination of care across the continuum and improve the efficiency and efficient patient care from the acute setting to post-acute/home.
* Interview, select, train, counsel, and evaluate staff; monitor trends to ensure sufficient staffing to provide appropriate levels of service to patients; ensure compliance with policies, procedures and rules/regulations (Organizational, state, and federal).
* Prepare annual budget, monitor departmental operations and objectives to ensure effective services are provided, Liaison for software vendor regarding support, maintenance, interfaces, new product development, installations and conversions.
* Provide support and guidance to the management team and staff who provide case management, social work and utilization services; serve as a resource for physicians and nursing concerning estimated length-of-stay, InterQual/Milliman criteria, third party payor guidelines, avoidable hospital days and discharge planning.
* Track and report source utilization trends including documentation to the Medical Staff Utilization Management Committee. Develop and generate specific reports and treatments/diagnosis reports; oversees the collection, analysis, and reporting of financial and quality data related to utilization, quality improvement and performance improvement and is accountable for achieving established performance targets through actively engaging multiple disciplines and professional staff.
* May complete unit/department specific duties and expectations as outlined in department documents.
REQUIRED QUALIFICATIONS
Master's degree in Nursing or a health related field. For internal employees: Master's Degree within five (5) years as a condition of continued employment in this job classification.
Seven (7) years of RN experience.
Missouri Board of Nursing RN or Nursing Licensure Compact multi-state RN. When primary state of residency changes, compact state RNs must apply under new state of residency within thirty (30) days.
Case management, utilization review, supervisory or management experience.
PREFERRED QUALIFICATIONS
Additional licensure/certification requirements as determined by the hiring department.
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