Director, Clinical and Transformative Case Management (Evergreen)
Director, Clinical and Transformative Case Management
Seated: California or Connecticut
We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care.
We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives.
Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.
The Transformative Leader will facilitate coordination, communication, and collaboration with patients, providers, ancillary services, and leadership to achieve goals and maximize patient outcomes.
Best practice focus will be placed on the provision of care in the most appropriate clinical setting, efficient patient management through rounding and ever-present leadership, and leadership escalation to ensure appropriate use and timeliness of services.
Under the direction of the National VP, Strategic Revenue Optimization, the Director of Case Management is responsible to orient, guide and oversee the Case Managers/Social Workers within Prospect Medical Holdings entities.
Job Responsibilities/Duties
Plan, develop, implement, evaluate, refine case management/social work intervention and provide supervision, oversight and guidance to the Case Management staff for discharge planning services in a Triad Case Management Model.
Responsible for hiring, coaching, performance management and corrective action as needed.
Develop job descriptions, competence and performance standards, staffing schedules, monitor assignments and assess activity levels to meet budgetary guidelines.
Ensure the Case Managers/Social Workers assess, plan, and deliver care appropriate to the age & clinical specifications of every patient.
Demonstrate consideration for the needs, clinical and financial, of the patients, payers, Case Managers, and Social Workers personnel.
Implement and support a culture of continuous quality improvement, support the CMSA standard of practice, URAC guidelines, code of professional conduct, and the federal and state regulations on confidentiality, as well as all policies and procedures Prospect Medical Holdings Hospitals.
Develop the team objectives and goals with support to the organization and departmental strategic plans.
Expected to pursue ongoing education, certification, and self-development to remain current with industry standards and business objectives related to Case Management.
Qualifications
Minimum Education: Bachelor Degree in Healthcare or Business Related Field required.
Masters of Science in Nursing preferred.
Minimum Experience: Seven (7) years of experience in an Acute Care Case Management/Utilization Review role, with at least three (3) years in a management level role required.
Excellent verbal and written communication skills with fast paced problem-solving skills and the confidence to quickly implement resolutions.
Fluency of standard utilization screening tools such as MCG and InterQual.
Interqual or MCG Certified Instructor preferred.
Expertise in operationalizing and executing a Case Management Plan.
Keen understanding in Emergency Room Operations.
Keen understanding of Daily Discharge Multi-Disciplinary Meetings.
Advanced experience with Allscripts Care Management tools or other like management tools.
Experience with Case Management & EMR Systems; such as, EPIC, Meditech, Cerner.
Soarian, Allscripts Care ManagementKnowledge of DRG, Value Based, Risk Based and Per Diem payment methodologies. Knowledge of all Federal, State and Local regulatory standards.
Advanced level knowledge of healthcare systems and applications to be able to successfully plan and coordinate activities and serve as a key resource to staff and others across the organization.
Excellent written and verbal communication skills in English.
Management experience in a large multi-entity healthcare organization preferred.
Previous Experience providing training in a corporate setting preferred.
Experience across multiple healthcare settings (Ambulatory, Acute Care, Long Term Care) preferred. Candidates should live within driving distance of one of our hospital systems (PA, CT, RI, or CA).
Req.
Certification/Licensure: Current Licensure as a Registered Nurse required.
CCM and other relevant certification preferred.