Director of Care Management

2 hours ago


Covington, United States Piedmont Newton Hospital Full time
Care Management Department Overview

The Director of Care Management will lead the Care Management department at Piedmont Newton Hospital, defining and maintaining standards of practice for service delivery and organizational performance strategies consistent with the hospital's Mission, Vision, and Values.

Key Responsibilities

1. Provide performance improvement, operational, human resources, and financial management of the Care Management department.
2. Ensure that Care Management services, including case management and social work, are delivered in accordance with evidence-based guidelines, established standards of care practice, and performance, hospital policies, and procedures.
3. Pursue strategies and day-to-day operations that promote quality patient throughput in a resource/cost-effective manner via effective care coordination and discharge planning.
4. Ensure that department operations and delivery align with hospital 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. Report on a regular basis with the Chief Financial Officer regarding Care Management department performance.
8. Implement and ensure collaborative working relationships with hospital and leadership, the Utilization Management (UM) team, and centralized functions, physicians, nursing, ancillary services, and other key stakeholders.
9. Work closely with UM leadership and Revenue Cycle to ensure issues are addressed in a timely manner, and that functions and processes align.
10. Oversee monitoring of staff utilization based on workload, skill level, acuity, and economic constraints.
11. Participate in Director and Leadership activities for the hospital and PHC.
12. Actively participate in strategic planning.
13. Ensure a safe work environment for CM staff.
14. Ensure appropriate training and resources are available to all staff within budgetary constraints, and promote professional growth of all staff.
15. Ensure that staff are consistently informed of departmental, hospital, PHC, and general CM issues.
16. Delegate responsibilities to appropriate personnel and ensure completion in a timely and effective manner.
17. Notify and consult with Risk Management as appropriate and per policy.
18. Provide leadership in recruitment and retention activities; perform or participate in screening, interviewing, and selection of employees.
19. Implement 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, The Joint Commission, and industry standards.
21. Perform outreach activities with community-based provider practices and agencies to promote care coordination and support the CM departmental, hospital, and PHC goals, as appropriate.

Qualifications

MINIMUM EDUCATION REQUIRED:
Graduate from an accredited school of nursing or Bachelor's degree in Social Work, Healthcare Administration, or other related field.
MINIMUM EXPERIENCE REQUIRED:
Seven (7) years of case management or social work experience in an acute care setting, to include three (3) years of management experience in the acute setting.
Comprehensive knowledge of the healthcare industry, care coordination, familiarity with government 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 current unrestricted licensed Master Social Worker (LMSW), or licensed Clinical Social Worker (LCSW) or eligible for licensure, in the state of Georgia required.
Certification in Case or Care Management preferred.
Additional certification or Master's degree in healthcare administration and/or finance preferred.

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