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Regional Director of Case Management
3 months ago
Description:
General: Responsible and accountable for system-wide case management within St. Mary's Health Care System: formulates and executes departmental budgets, conducts periodic budgetary reviews, evaluates cost management strategies, and develops strategic departmental plans. Responsible for the administration, coordination, and evaluation of case management services: Formulates staffing model for departments/division. Participates and guides in performance improvement activities to facilitate effective use of resources to manage quality of care. Accepts responsibility for regulatory compliance of federal, state and JC standards that are related to departments managed. Facilitates and develops productive working relationships with system management, physicians, staff and the community. Exemplifies leadership and concern for health care as a representative of St. Mary's in the community and health care settings.
Case Management: Has overall responsibility of case management, utilization review, and transition planning across St. Mary's Athens, Sacred Heart Hospital and Good Samaritan Hospital. Has overall policy and operational responsibility for utilization review, care coordination, transition planning, and compliance with other payer-specific requirements, to avoid denials of payment, effectively manage length of stay, mitigate avoidable readmissions, and maintain strong community collaboration with other health care services providers. Works closely with senior leaders and directors to ensure that contracts are reviewed and operational measures are in place to maximize reimbursement and minimize lost revenue, in accordance with utilization management and care coordination requirements.
Position Requirements:
Licensure/Certification/Registration:
Current Georgia professional registered nursing license, as well as professional certification in case management, are required. Active memberships in professional case management and education organizations are recommended.
Responsibility: Directly reports to the Vice President of Nursing.
Knowledge: Must have a thorough knowledge of care management principles and their application throughout the care continuum, understands the principles and practice of education and performance improvement processes, is proficient in the application of policies/ procedures, interpretation of regulatory/ accreditation issues for case management, education, patient care, age specific and employment practices.
Skills: Strong computer proficiency required in multiple software applications, excellent written and oral communication skills, must be highly organized and able to meet deadlines, ability to empower staff, accounting skills, ability to coach, educate, and create a team spirit.
Education: Graduate of an accredited school of nursing required; Master's degree in nursing, business, or health related field required.
Experience: Minimum of 5 years in management/administration in a health related occupation required. Three or more year's clinical experience required. Regional/system/corporate healthcare leadership experience preferred.
Initiative and Judgment Required: Must exhibit a high degree of initiative and decision making qualities, in coordinating and evaluating services provided throughout the health care system. Must exercise sound judgment in carrying out duties and collaborating with various personalities/cultures/age groups. Must have the ability to analyze data and make intelligent decisions. Should be versatile and enjoy the challenge of a variety of duties and with a strong ability to manage multiple competing priorities.
Relationships: Ability to develop and maintain effective working relationships as well as with complex and varied departments and culturally diverse staff within the system. Develop collaborative working relationships with physicians and other community health care providers. Ability to work with management, staff, and other professions from all areas of the health care system.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.
