Education / Experience: - Master’s Degree in Nursing or Social Work required.
- Master’s degree in related health or business field desirable (MHA, MBA).
- Eight years of progressive acute care management leadership experience in an integrated, multi-campus health system, preferably with an academic medical center.
- Experience in strategic planning and program development at a system level preferred.
Reports To: System Chief Nurse Executive, Sr. Vice President of Clinical Operations Essential Functions:
1. Exemplifies the WFBH Standards of Behavior and Code of Conduct, while striving to identify compliance risk through department led risk assessments, system monitoring, and periodic audits, and reporting any identified violation to Legal Services and Corporate Compliance Departments. Ensures immediate action is taken on any issues identified through a self-assessment or by Legal Services or Corporate Compliance; that policies are developed or revised as necessary; and that efforts are made to ensure a positive and compliant work environment for all employees. 2. Demonstrates leadership in the areas of: - Human Resources
- Financial Management
- Regulatory Compliance
- Planning
- Directing
- Continuous quality improvement
- Institutional support and representation
- Customer service
- System integration
3. Directs the activities, functions and management of personnel and of the program across the system to ensure that quality, age/developmentally appropriate care is provided according to the WFBH mission, departmental objectives and all internal/external regulations, policies and procedures.
4. Ensures a consistent effort toward quality improvement, employee engagement, patient-centered care, and customer satisfaction. Leads operational improvements that facilitate standardization of care management services across the organization and across the continuum of care, directly or through the influence of others at the system, service line, or local level. 5. Develops and participates in clinical management projects to ensure effective, efficient care that is responsive to patient care needs with measurable quality outcomes. Coordinates system-wide reporting of metrics and outcomes, holding associates accountable for accurate and timely data submissions. Analyzes and interprets data to direct improvement efforts. 6. Incorporates and integrates related theories, evidence, practice standards and other established knowledge into standardized processes and functions, applying current leading practice trends where applicable. 7. Establishes and maintains strategies that facilitate the transition of care delivery for patients with multiple provider agencies or network settings.
8. Promotes effective clinical management, communication and collaboration with members of inter- disciplinary team.
9. Oversees compliance with regulations, laws and ethics via audits and direct observation.
10. Contributes to the ongoing refinement of the strategic plan for case management services, identifying resources needed, risks and contingency plans. 11. Develops a network of care coordination colleagues across the country to maintain awareness of ongoing regulatory and legislative changes and methods to maintain compliance, and to stay abreast of leading practice trends.
12. Protects self, co-workers and facility by following approved policies and procedures to prevent the spread of blood-borne and/or airborne diseases.
13. Establishes partnerships with executives, medical staff, chief nursing officers, chief medical officers, patient financial services, and other key leaders across the health system related to care coordination, post-acute services, service affiliations and joint ventures.
14. Participates in review of organizational system contracts for issues pertaining to denials management, timelines for authorization of services, and other case management-related agreements.
15. Maintains a working knowledge of applicable federal, state and local laws/regulations as well as other compliance requirements (e.g. The Joint Commission, WFBH Conflict of Interest policies, etc). Skills and Qualifications: - Able to set and organize own work priorities and adapt them as they change
- Able to work concurrently on a variety of tasks/projects in a stressful environment
- Able to make sound and timely decisions, to think critically, and to problem solve in a fast-paced environment
- Excellent interpersonal and communication skills - Able to build and motivate teams in a culture of accountability
- Working knowledge of chronic conditions, evidence-based guidelines, prevention and wellness
- Able to develop chronic disease management strategies and appropriate protocols and guidelines
- Demonstrated program/project management and data analysis skills in population health management including population health analytics and disease management, and financial optimization
- Experience in developing education curriculum and programs for care management
- Solid working knowledge of managed care and governmental payment policies
- Demonstrated ability to lead through metrics and keen understanding of day to day operations
- Demonstrated ability to lead large-scale transformational change in health care at the organizational/system level and to work effectively with all levels in the organization, individual and team, across disciplines and geography
- Strong fiscal and clinical management skills - Strong computer skills (data base and data analysis) |
