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Director Care Management

4 months ago

Lufkin, United States Catholic Health Initiatives Full time

**Overview**

St. Lukes Health-Memorial paves the way for quality innovative health care in East Texas and provides more than a quarter of a million patient services each year. With hospitals in Lufkin Livingston and San Augustine St. Lukes Health-Memorial provides millions of dollars in charity care and community support each year.

Responsible for planning, organizing, directing and controlling the integrated care program, which includes case management, social services and discharge planning. Oversight of Case Managers, Social Workers & Discharge Coordinator and is primarily responsible for ensuring that patient care is integrated between payers and providers, thus resulting in cost-effective quality care for all customers. This includes direction of the operational, financial and personnel Functions of the Care Management Department. Participation in the coordination and reporting of quality enhancement activities and cost- related outcomes is essential. Active involvement in evidenced based proactive activities is required for both clinical and system redesign which will enhance quality and financial outcomes. Maintains current knowledge of CMS and OIG regulations, including but not limited to, reimbursement trends in the Managed Care arena. Must keep department employees focused as the healthcare market and managed care evolvement and changes. Displays professional, safe conduct in all interactions. Maintains positive working relationships with staff, other departments, physicians and peers. Displays conduct in support of CHI St. Lukes Health Memorial Mission and Vision.

**Responsibilities**

1. Quality completes work with accuracy and thoroughness.

2. Productivity efficiently utilizes time in accomplishing work.

3. Customer Focus lives organizational and departmental service standards.

4. Reliability completes tasks assigned; follows up as needed.

5. Availability meets attendance standards; is punctual; works when needed.

6. Decision Making displays sound judgment; works with minimal supervision.

7. Initiative seeks out productive duties in absence of guidance; is a self-starter.

8. Adheres to Policy follows CHI St. Lukes Health Memorial rules, policies, procedures and guidelines.

9. Interpersonal Relationships cooperates, communicates and works well with others.

10. Professionalism represents CHI St. Lukes Health Memorial positively in actions and appearance.

11. Directs the planning, implementation and daily operation of the hospital care management program and social service program in compliance with regulatory and accreditation agencies.

12. Accepts multiple management tasks to handle financial, operations, managed care and staffing issues within the Center for Integrated Care department.

13. Serves as clinical advisor to care management across the continuum of care for all payment programs. This includes participation in program development, facility network development and relations, and physician network development and relations; patient tracking across the continuum of care; and decisions regarding alternatives to acute care which consider quality and financial factors.

14. Maintains relationships with medical staff members, vice presidents, nurse managers, department manager and technical directors to support intradepartmental goals and advise on activities pertaining to outcomes, case and social management.

15. Plans, organizes, directs and controls the operational activities of the Center for Integrated Care (CIC), assuming responsibility for quality and productivity. Develops, Implements and administers departmental policies and procedures.

16. Develops and adheres to budget recommendations, administration of operating and capital budget, approval of all financial expenditures, and reconciliation of budget variances.

17. Performs personnel management activities assuring consistency of application of employee relations' policies for hiring, performance evaluation, salary adjustment, counseling and termination. Proactively promotes methodologies that positively affect patient care and staff productivity.

18. Acts as liaison to the Information Systems Department to assure department Functions are appropriately supported with hardware and software to meet regulatory requirements and increase productivity through Midas training and updates.

19. Gains and/or expands knowledge basic income statements and balance sheets. Fosters and promotes positive and professional relationships with physicians, physician office staff, other referral sources and insurance companies.

20. Demonstrates tact and professionalism in working and communicating with patients/families, physicians, other members of the rehabilitation team, and other employees of the healthcare system.

21. Adheres to CHI St. Lukes Health Memorial policies, including but not limited to CHI Values & Ethics at Work, HIPPA, PHI, ePHI, Privacy Rule, and confidentiality.

22. Maintains safe work habits; adheres to safety rules; immediately reports any unsafe condition; immediately reports any incident / injury.

23. Supports department-based goals and contributes to the success of the organization.

24. Complies with hospital policies and procedures; attends required in services, education and training.

25. Performs duties in accordance with that of hospital policies and procedures, and regulatory agency guidelines.

26. Demonstrates a willingness to follow the chain of command, regularly channels suggestions, criticisms and complaints to the appropriate person.

27. Performs other duties as assigned.

**Qualifications**

Required Education:

* Master's degree

Required Experience:

* Seven (7) years experience in the discipline

* Five (5) years leadership experience

Required Licensure & Certification:

Registered Nurse

BLS

Case Management Certification required within 2 yrs of employment

#LI-CHI

**Pay Range**

$44.62 - $64.69 /hour

We are an equal opportunity/affirmative action employer.