Piedmont Rockdale Hospital - Conyers, Georgia
JOB PURPOSE: The Director of Care Management is responsible for leading the hospital’s Care Management department, defining and maintaining standards of practice for service delivery and organizational performance strategies consistent with PHC’s Mission, Vision and Values, as well as those of the individual hospital.
1. Provides performance improvement, operational, human resources and financial management of the Care Management department.
2. Ensures that Care Management services, which include 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. Ensures that department operations and delivery align with PHC 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. Reports on regular basis with Chief Financial Officer regarding Care Management department.
8. Implements and ensures collaborative working relationship with hospital and PHC
leadership, the Utilization Management (UM) team and centralized functions, physicians, nursing, ancillary services and other key stakeholders.
9. Works closely with UM leadership and Revenue Cycle to ensure issues are addressed in a timely matter, and that functions & processes align.
10. Oversees monitoring of staff utilization based on workload, skill level, acuity and economic constraints.
11. Participates in Director and Leadership activities for hospital and PHC.
12. Actively participates in strategic planning.
13. Ensures a safe work environment for CM staff.
14. Ensures appropriate training and resources are available to all staff within budgetary constraints, and promotes professional growth of all staff.
15. Ensure that staff are consistently informed of departmental, hospital, PHC and general CM issues.
16. Delegates responsibilities to appropriate personnel and ensures completion in a timely and effective manner.
17. Notifies and consults with Risk Management as appropriate and per policy.
18. Provides leadership in recruitment and retention activities; performs or participates in screening, interviewing and selection of employees.
19. Implements 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. 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.
KNOWLEDGE, SKILLS, ABILITIES
• Visionary leader with a systems thinking approach
• Ability to identify opportunities for improving customer service and building collaborative relationships to achieve optimal outcomes
• Ability to work well under pressure and/ in high stress situations
• Effectively manage time
• Effective communication
• Ability to delegate and manage effectively
• Work under minimal supervision
• Knowledge of hospital audit and accreditation process by a hospital accreditation organization such as Det Norske Veritas (DNV) or The Joint Commission.
MINIMUM EDUCATION REQUIRED: Bachelor’s degree from an accredited school in nursing, social work, healthcare administration or other related field.
MINIMUM EXPERIENCE REQUIRED:
Extensive, at least ten (10) years of clinical and case management or social work experience, and three 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.
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
Additional certification or Master’s degree in healthcare administration and / or finance preferred