Care Management Leadership Position at Piedmont Newton Hospital
1 week ago
Piedmont Newton Hospital is seeking a skilled and experienced Director of Care Management to lead our care management department. This individual will be responsible for defining and maintaining standards of practice for service delivery and organizational performance strategies consistent with the hospital's mission, vision, and values.
Key Responsibilities:
• Provide performance improvement, operational, human resources, and financial management of the care management department.
• Ensure that care management services are delivered in accordance with evidence-based guidelines, established standards of care practice, and performance, hospital policies, and procedures.
• 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.
• Ensure that department operations and delivery align with hospital and industry quality standards.
• 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.
• Monitor effectiveness by analyzing Average Length of Stay, Case Mix Index, avoidable days, denials, and other key metrics.
• Reports on regular basis with Chief Financial Officer regarding care management department.
• Implements and ensures collaborative working relationship with hospital and leadership, the Utilization Management (UM) team, and centralized functions, physicians, nursing, ancillary services, and other key stakeholders.
• Works closely with UM leadership and Revenue Cycle to ensure issues are addressed in a timely matter, and that functions & processes align.
• Oversees monitoring of staff utilization based on workload, skill level, acuity, and economic constraints.
• Participates in Director and Leadership activities for hospital and PHC.
• Actively participates in strategic planning.
• Ensures a safe work environment for CM staff.
• Ensures appropriate training and resources are available to all staff within budgetary constraints, and promotes professional growth of all staff.
• Ensure that staff are consistently informed of departmental, hospital, PHC, and general CM issues.
• Delegates responsibilities to appropriate personnel and ensures completion in a timely and effective manner.
• Notifies and consults with Risk Management as appropriate and per policy.
• Provides leadership in recruitment and retention activities; performs or participates in screening, interviewing, and selection of employees.
• Implements Human Resources policies for performance plans, deployment, severance, outplacement, and other policies that support appropriate utilization of workforce resources.
• Ensure that personnel and competency files are maintained in accordance with hospital, PHC, The Joint Commission, and industry standards.
• Performs outreach activities with community-based provider practices and agencies to promote care coordination and support the CM departmental, hospital, and PHC goals, as appropriate.
Estimated Salary Range: $120,000 - $160,000 per year, depending on experience and qualifications.
Requirements:
MINIMUM EDUCATION REQUIRED:
Graduate from an accredited school of nursing or Bachelors 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 Masters degree in healthcare administration and/or finance preferred.
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