Director, RN Case Management

2 weeks ago

Milford, United States Yale New Haven Health Full time

Overview: To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

EEO/AA/Disability/Veteran

Summary: The YNHHS Inpatient Director of Case Management will provide strategic and operational leadership for all Case Management services across the Yale New Haven Health System. This position will help transform the practice of Case Management so that the team advances the practice of medical care, drives innovation, enables patient-centered solutions and coordinates with a variety of post-acute partners (SNFs, Home Care, Physician Practices, etc.) to optimize a patient's ability to reach their most appropriate discharge disposition that meets their needs. This position will partner with our Clinical Service Lines, Social Work team, and Complex Care Team as well as the post-acute team to help further this mission. This position will work closely with the Director of Social Work.

Responsibilities: 1. Optimize collaboration with Clinical Service Lines. Provide strategic and operational partnership and collaboration with all our clinical services and deploy staff to meet those unique needs while maintaining and furthering the unique profession of Case Management. Partner in new and creative ways to further the care of these unique patient populations. 2. Optimize the work of the Case Manager and Transition Coordinator in new and innovative ways. The roles of the Case Manager and Transition Coordinator need to evolve continuously to facilitate increased advocacy, increased clinical knowledge, more patient responsibility, and embracement of new technologies which facilitate the discharge process and decrease length of stay. The YNHHS Director will provide clarity of roles and responsibilities and align policies and procedures to meet these needs. He or she will also be the change agent for the department to practice in a more patient-centered fashion. 3. Further partnership with Capacity Coordination Center and data driven processes. Embrace data driven outcomes and hardwire this approach into the work of the department. Align with the Capacity Coordination Center to enhance patient flow and identify patient priorities that Case Management can help drive and manage daily. 4. Enhance collaboration with a variety of post-acute partners, driving more patients to care at home when appropriate. It is critical for this role to work with a variety of post-acute partners including SNFs, Home Care Agencies, LTACHS, along with ambulatory providers including primary care providers and specialists. The Director will work in collaboration with the YNHHS post-acute team and the Care Navigation Center to establish strategy and execute on its goals, including optimizing utilization of the Coordinated Care Network. Much effort will be spent optimizing home-based care for our patients including provision of acute care in the home through the YNHHS Home Hospital program. 5. Collaborate and support the transition to value-based care and alternate payment models. YNHHS will continue to participate in several value-based care initiatives either through a CIN and/or with our commercial/government payors. Case Management will support these efforts in driving appropriate management and patient-centered utilization of services. 6. The Director will provide supervision to managers and promote their growth as leaders in the system. 7. Readmission reduction. A priority of Case Management will remain a reduction in the number of unnecessary hospital readmissions and work to mitigate potential readmissions both before and after discharge. The department will also align with other key Quality initiatives. 8. Length of stay management. The Director will need to manage a multitude of external relationships with providers, facilities, payors and government to fine creative and sustainable locations to provide ongoing care for patients that struggle with appropriate discharge disposition. 9. Link to Utilization Review and other key partners. Will need to work collaboratively with Utilization Review, Physician Advisors, Denial Management and Finance, Social Work, and others to optimize work and workflows and assist others in meeting their needs and goals. 10. Maintenance of regulatory requirements. The Director will maintain current knowledge of governmental regulations that affect the practice of case management as well as familiarity with insurance plans in Connecticut, New York, and Rhode Island. 11. This is an evolving role in a dynamic department that will evolve so responsibilities will continue to grow and develop. Will work collaboratively with Social Work and key partners to advice the work at hand.

Qualifications: EDUCATION: Master's degree in nursing or business or other related health science degree.

EXPERIENCE: Five (5) years of nursing/medical leadership experience with working knowledge of issues related to patient flow, transitions of care, post-acute needs and services, regulatory requirements, patient-centered care, workflow optimization, and institutional quality and financial goals.

LICENSURE: State of Connecticut RN license required.

SPECIAL_SKILLS:

Experience directing other clinical areas, working closely with physicians, developing clinical strategies, implementing operational efforts, and measuring outcomes. Experience in using word processing, spreadsheets, database, internet, and e-mail.

ACCOUNTABILITY: Role reports to Executive Director of Care Management. Critical relationships with medical and nursing leadership at each delivery network.

COMPLEXITY: Able to deal with clinical leaders from all services in challenging political environments as well as manage complex individuals and inappropriate acts. Must be viewed as neutral and unbiased. Works well with operational leaders and manages conflicts.

PHYSICAL_DEMAND: Experience directing other clinical areas, working closely with physicians, developing clinical strategies, implementing operational efforts, and measuring outcomes. Experience in using word processing, spreadsheets, database, internet, and e-mail.

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