Manager of Hospital Care Coordination

1 week ago

Reno, Nevada, United States Renown Health Full time
Position Overview
This role is pivotal in overseeing the Hospital Care Coordination Department.

The primary aim of the Hospital Care Coordination program is to enhance care quality, achieve cost-effective patient outcomes, and optimize resource utilization while addressing the needs of patients, families, referring physicians, agencies, and payers.

This position acts as a vital resource and support for staff in navigating care coordination across various services. The incumbent will have access to sensitive patient and hospital information and will make decisions independently or in collaboration with others.

Key Responsibilities
  • Plan, organize, manage, and evaluate the Utilization Management and Case Management teams.
  • Monitor the achievement of program objectives and implement necessary changes to enhance outcomes.
  • Collaborate with the Manager to prepare, administer, and oversee departmental operating and capital budgets, ensuring adherence to allocated funds.
  • Contribute to the development of departmental policies and procedures, ensuring proper staff allocation and assignment based on patient and organizational needs.
  • Initiate hiring and termination processes, conduct timely annual evaluations, and provide coaching.
  • Schedule and oversee assignments, managing staffing levels to align with budgetary constraints.
  • Offer counseling, training, and address any disciplinary issues.
  • Maintain a supportive approach towards departmental and organizational goals, plans, policies, and procedures.
  • Promote the significance of utilization management and case management within the Health System through effective collaboration with managers, directors, and physician leaders.
  • Engage in the planning and development of educational programs for Utilization Management and Case Management staff, coordinating and documenting departmental orientation and training.
  • Provide expertise and guidance to Hospital Care Coordination staff in resolving complex clinical and financial patient issues related to reimbursement, discharge planning, utilization review, and continuity of care.
  • Foster a culture of continuous quality improvement, working collaboratively within a team to manage the overall function of the Hospital Care Coordination service. Actively participate in organizational committees.
  • Engage in professional association activities.
  • Encourage a positive and safe work environment.
  • Stay informed of current professional standards in healthcare and recommend policy and program changes as necessary.
  • In collaboration with the treatment team, attending physician, and external entities, may provide direct patient care.
  • Perform additional related duties as assigned by Health System Administration.

Knowledge, Skills, and Abilities:
  • Comprehensive understanding of Medical Terminology.

Demonstrated Knowledge of:
  • Utilization Management and Case Management principles and methodologies.
  • Levels of Care (Acute care, Critical Care, Acute Rehab, LTAC, SNU, Subacute, Outpatient, Home Health, Day Treatment).

Thorough Knowledge of:
  • Government, county, private, and workers' compensation funding sources.
  • Eligibility criteria and criteria for determining levels of care, along with familiarity with managed care (HMO, PPO, PSO, and capitation).
  • Federal and State regulatory requirements and URAC standards.

Demonstrated Ability to:
  • Effectively communicate with healthcare professionals and external case managers.
  • Identify obstacles to patient progress and barriers to discharge.
  • Collaborate with the medical team to address and resolve such barriers.
  • Maintain professional relationships and work effectively with other members of the medical team.
  • Pursue continuing education and training opportunities in Utilization Management or Case Management.
  • Stay updated on standards of care, case management/utilization principles, Social Services, discharge management, and Spiritual Care.
  • Uphold confidentiality regarding medical records.
  • Understand insurance and payer requirements.
  • Demonstrate the knowledge and skills necessary to provide age-appropriate care based on physical, motor/sensory, psychosocial, and safety considerations.
  • Exhibit competency in performing job duties as demonstrated by current RN licensure and departmental evaluations.
This position may involve direct patient care.

Disclaimer: The above description is not intended to be an exhaustive list of all responsibilities, skills, and efforts or work conditions associated with the job. It is meant to accurately reflect the general nature and level of the position.

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