Director Care Management at Providence

Director Care Management
Santa Monica, CA

Req ID: 319981
Job Category: Care Management
Shift: Day
Schedule: Full time
Work Location: Providence Saint John's Health Ctr-Santa Monica

THE ROLE
The Director, Case Management promotes and supports the mission, vision and objectives of Saint John's Health Center and is responsible and accountable for the clinical, fiscal, and personnel management of Case Management on a 24 hour, 7 day basis. Develops and utilizes mechanisms for directing, evaluating and controlling operational activities towards accomplishments of division effectiveness and efficiency. Develops collaborative relationships with physicians and all departments. Participates in the development of strategic plans and programs. Assures compliance with all state and federal laws and other regulatory requirements, in all areas of responsibility.

ESSENTIAL FUNCTIONS

• Prioritizes and directs implementation of short and long term goals to support the division and hospital fiscal objectives.
• Prepares annual budget for areas of responsibility and controls operational activities towards accomplishment of departmental efficiency.
• Analyzes budget variances monthly, and prepares reports.
• Ensures continuity and follow-through in daily operations.
• Controls expenditures to within division-wide budgeted amounts.
• Facilitates optimal utilization of personnel and material resources.
• Proactively identifies and initiates cost reductions strategies and efficiencies.
• Interview and hires staff who have the skills, knowledge, and values consistent with SJHC.
• Serves as Chief Retention Officer to implement strategies to both recruit and retain staff.
• Counsels employees and ensures adherence to health center policy and practice.
• Conducts regular evaluations of performance on a timely basis.
• Responds to customer (patient and physician) concerns in a responsive, timely, and respectful manner. Thoroughly reviews system to make changes where appropriate to improve the process and avoid repetition of issues.
• Participates in the identification, study of feasibility, and development of the services line through strategic plans/policies, in collaboration with CMO, Administrative Director, Safety and medical/program directors. Implements strategies that contribute to and support the organization s direction.
• Design, facilitates and/or implements quality improvement projects to improve patient care process/systems for division of responsibility. Incorporates results of customer and staff surveys into quality improvement projects.
• Writes business plans as needed, including development of financial pro formas in collaboration with the Finance Department.
• Negotiates contracts with payers, physicians, and service line vendors, in concert with CMO and the Finance Department.
• Ensures that adequate human resources are provided, retained and utilized in an efficient manner to maintain objectives of the organization. Promotes excellence and professional growth of staff through mentoring and staff development.
• Facilitates teamwork and effective flow of ideas by engendering an environment of trust characterized by openness, honesty, and fairness. Promotes team ownership of projects, goals, and department responsibilities.
• Promotes and develops strategic relationships with physicians, facilitates good working relationships between physicians and staff, and maintains a high level of professionalism and good humor in working with physicians.
• Facilitates effective communication between and among patients, family, staff, physicians and other departments or divisions within the Health Center, as well as with the Executive Team.
• Prepares and presents oral and written reports including graphic and visual.
• Complies with Health Center and division standards, including but not limited to safety, infection control, performance improvement, confidentiality, staff education and competencies.
• Ensures division s compliance with all personnel, organizational, accrediting and licensure standards, and with state and federal laws.
• Position Specific:
• Create, gain approval for, implement and monitor a model for integrated coordination function, involving registered nurse, and social work case managers and other relevant professionals that measurably improve performance.
• Create, and analyze utilization review metrics, maintained in the form of a dashboard, ensuring appropriate length of stay and cost per case.
• Ensure daily patient Interqual assessment and appropriate level of care positioning throughout the hospital experience.
• Complete ongoing educational needs assessment, identifying areas for improvement, in addition to providing education on continual changes in Medicare regulation and reimbursement.
• Form positive relationships with surrounding healthcare providers, establishing improved continuity of care and smooth transition across the continuum. Consider opportunities for formal contracted relationships with local nursing homes and long term acute care facilities.
• Facilitate Resource Management Committee, including collaboration with physicians, and suggesting methods for provision of efficient, quality care.
• Collaborates with Financial Admitting case manager and other departments as needed to ensure that all medical necessity review processes are performed and are complete, accurate and timely.
• Provides oversight and secondary review when required for admissions and prevents inappropriate admissions (evaluating medical necessity and inappropriate level of care) by collaborating with Financial Admitting case manager, Admitting, Emergency Dept, and Admitting physicians to ensure appropriate utilization of resources. Attends daily Bed Rounds meeting and communicates with Administration and other Directors to ensure appropriate utilization.
• Refers appropriate cases to the Physician Advisor where there are concerns or questions regarding treatment, utilization patterns, etc. Gathers and analyzes utilization data, and collaborates with other health care professionals and departments including Risk Management & Quality Management. Identifies trended problems and educates staff concerning pertinent issues.
• Responsible for final review of all Medicare 1 Day Stays, i.e., verification of clinical review and for presenting monthly report on Medicare 1 day stay to appropriate committees.
• Provides oversight for Monitoring and tracking of all Outpatients to Inpatients, i.e., all outpatients that need to be converted to inpatients and are approved by financial case manager or Supervisor.
• Leads performance improvement activities for case management. Creates strategies to positively impact the attainment of targeted goals and outcomes.

QUALIFICATIONS

• Graduate of a recognized registered nurse program
• Master's Degree in Nursing, Business, Healthcare Administration, or other related field (preferred)
• Upon hire: California Registered Nurse License (Vendor Managed)
• 5 years of direct patient care experience
• 3 years of supervisory experience
• Recent clinical experience in case management, hospital operations, accreditation standards, healthcare regulations, and policy formation
• Effective organizational, oral and written communication skills, problem solving, program development, strong leadership, and team building skills
• Ability to work with a variety of disciplines and all levels of staff across the health system
• Computer literacy, i.e., basic Microsoft computer applications with Outlook, Word, Excel, PowerPoint, skills required, and ability to type 35 wpm
• Preferred expertise in application of InterQual criteria and Case Management software products, e.g., McKesson InterQual
• Advanced knowledge of case management, hospital operations, accreditation standards, healthcare regulations, and policy formation.

About Providence
At Providence, our strength lies in Our Promise of Know me, care for me, ease my way. Working at our family of organizations means that regardless of your role, we ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

Pay Range: $93.07 - $149.81

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

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