Care Management Director

1 day ago

Kenosha, Wisconsin, United States Advocate Health Full time
Care Management Director Job Description

Job Summary:

The Care Management Director will provide leadership and oversight of the Care Management program and staff for Advocate Health. This includes direct management and development of site Care Management staff, as well as collaboration with Hospital Leaders, Post-Acute Partners, Physicians, Physician Advisors, Nurses, and others to ensure accurate and timely progression of care, discharge planning, and compliance with regulatory standards/conditions of participation related to discharge planning and utilization management.

Key Responsibilities:

  • Program Management: Provides management oversight of the daily operations of the Care Management program at the assigned site(s). Approves and monitors staff schedules, paid time off, and time cards to ensure continuity of services. Monitors proficiency of each site Care Management staff and includes action plans to improve deficiencies, meet regulatory requirements, and drive efficiencies.
  • Performance Improvement: Facilitates performance improvement activities for the Care Management program; assists to establish measures, performance targets, and benchmarks to drive achievement of established goals and achieve efficiencies of processes. Collects, analyzes, and reports data to measure and identify the effectiveness of care processes and variations from standards and expectations.
  • Collaboration and Communication: Identifies and discusses overall and individual physician trends related to care management activities with Director of Inpatient Care Management Operations, Physician Advisor, and site Medical Staff Leadership as appropriate with a documented improvement plan to include strategies and educational needs identified. Regularly reviews individual site successes and improvement opportunities with the Director of Inpatient Care Management Operations, site leadership, and other key stakeholders.
  • Expert Resource: Serves as an internal consultant on Care Management opportunities. Acts as an expert resource for the Care Management program, including evaluation of challenging cases, intervening with physicians when necessary, meeting with patients and families, dissemination and interpretation of key regulatory requirements and changes, etc.
  • Financial Management: Accountable for site Care Management budgets as assigned. Develops and recommends operational and capital budgets and controls expenditure within approved budget objectives.
  • Compliance and Regulatory: Ensures the Care Management program operates within compliance of CMS, OSHA, Accrediting Organizations, and established care management practice standards and code of ethics. Collaborates with Compliance to ensure the Care Management program meets all state and federal guidelines.
  • Staff Development and Management: Responsible for orientation, and ongoing competency assessment of Care Management staff in collaboration with the Director of Inpatient Care Management Operations.
  • Leadership and Professional Development: Responsible for personal professional growth. Participates in professional organizations, maintains license and certification as required, maintains effective working relations with both internal and external customers. Maintains required competencies and assumes responsibility of personal development and maintenance of ongoing workshops, conferences, and/or in-services and maintaining records of participation.
  • Human Resources: Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.

Requirements:

  • Licensure and Certification: Registered Nurse license issued by the state in which the team member practices, or Social Worker license issued by the state in which the team member practices and RN or SW: Accredited Case Manager (ACM) or SW (ACM) certification issued by the American Case Management Association (ACM) needs to be obtained within 1 year, or RN or SW: Certified Case Manager (CCM) issued by the Commission for Case Manager Certification (CCMC) needs to be obtained within 1 year, or RN: Nursing Case Management (RN-BC) certification issued by the American Nurses Credentialing Center (ANCC) needs to be obtained within 1 year, or SW: Certified Social Worker in Health Care (C-SWHC) issued by National Association of Social Workers to be obtained within 1 year
  • Education: Bachelor's Degree in Nursing or Master's Degree in Social Work
  • Experience: Typically requires 5 years of experience in a relevant clinical setting. Includes 1 year of supervisory experience in a Care Management Leadership role
  • Knowledge, Skills & Abilities: Master of Nursing Administration, Master in Health Care Administration or related field preferred. Ability to prioritize and organize work. Ability to travel and work across multiple sites as assigned (IL or WI). Effective communication skills. Utilization of critical thinking in timely decision making. Knowledge of MS Office products. Demonstrates leadership skills. Knowledge of Medicare A and B guidelines. Knowledge of Managed Care programs/requirements/implications. Knowledge of Conditions of Participation for Discharge Planning. Knowledge of requirement elements of Utilization Management program, including support of the UM Plan. Knowledge of Regulatory environment. Ability to work autonomously and respond to multiple requests effectively.

Physical Requirements and Working Conditions:

  • Must be able to sit for approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time.
  • Must lift up to 10 lbs. continuously, up to 20 lbs. frequently, and up to 50 lbs. occasionally.
  • Manual dexterity required for operation computer and calculator.
  • Visual acuity required to facilitate review of written documents/computer screens, medical records, and to record information accurately.
  • Clear oral communications and hearing acuity required for receiving instructions and converse on standard telephone.
  • Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone.
  • Exposed to normal office environment; including usual hazards related to operating electrical equipment.
  • Operates all equipment necessary to perform the job.

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