The Corporate Director of Care Management is responsible for the system-wide Care Management, Utilization Management, and Utilization Review programs, functions, roles and responsibilities at all Shriners Hospitals for Children (SHC) locations. This position reports to the System Chief Nursing Officer and works collaboratively with nursing, medical, administrative, financial and clinical staff at the local and national levels. The Corporate Director Care Management provides strategic leadership and build processes to transition SHC into an enhanced model of care management ensuring effective and efficient transitions of care that are fiscally responsible, meet regulatory requirements and support excellent patient outcomes.
PROGRAM OVERSIGHT AND MANAGEMENT
In partnership with the Chief Nursing Officer, collaborates with Patient Financial Services, Health Information Management and Medical Affairs, directing the quality and performance criteria, policies and procedures, and standards for Care Management including utilization review, utilization management operations system-wide- 10%&ndash
Demonstrates strategic thinking in planning, implementing and evaluating programs tied to future growth of clinical operations. Develops and executes annual goals and objectives for SHC Care Management and provides the leadership, organization and change management necessary to achieve the key goals system-wide. Leverages SHC as well as industry data and trends to proactively address variances and achieve strategic goals specific to length of stay, patient and provider satisfaction - 10%
Participates in the collection, analysis and reporting of quantitative and qualitative financial and quality data to a variety of stakeholders to drive decisions and implement performance improvement strategies for the Care Management department. Monitors all high-risk/high cost/high utilization patient trend data and develops systematic interventions in regard to appropriate and effective care delivery, referral management, and contracting need - 10%
Works with the local Directors/Managers of Care Management to ensure system-wide continuity and alignment of care management operations, including psychosocial support, resource management, utilization management, utilization review and discharge planning. This may require redesign of internal processes and workflows as well as measurement frameworks to reflect industry best practices and SHC objectives - 10%
Conducts internal reviews to assess and evaluate services rendered, staffing levels, competency and ongoing educational needs of the care management staff. Implements appropriate staffing models to ensure delivery of proactive transition management; coordinated entry and exit from outpatient care, pre-admission to post-discharge; and psychosocial and resource support services. Creates work processes that are supportive of the care management team to ensure success and create a collaborative work environment resulting in an engaged and accountable team - 10%
Collaborates with Utilization Review, Clinical Documentation Improvement, Patient Financial Services, Medical Reviewers and providers to ensure appeals and reviews are conducted timely to avoid delays in inpatient and outpatient approvals, coordinating services and billing for those services. - 10%
Leads system-wide monthly video/teleconferences with Directors/Managers of Care Management. Provides ongoing education and review of system initiatives while fostering engagement and innovation. Ensures bi-directional communication with teams to ensure achievement of strategic objectives and continuity of care and services system-wide. Develops and revises policies pertaining to Care Management and monitors to ensure adherence. - 10%
Participates in the selection process of Directors/Managers of Care Management. Provides feedback and annual appraisal input to the Director of Patient Care Services/Nurse Executive relative to the Managers/Directors of Care Management performance. - 10%
Collaborates with SHC Information Systems (IS), informatics and other clinical stakeholders to develop and implement technology solutions that improve care efficiency. Provides clinical oversight for design decisions, functionality and training of new technology/tools implemented to support care management functions. Effectively implements new requirements utilizing the electronic medical record or other tools to optimize workflow. – 10%
The qualified candidate will have experience in the following areas:
5 or more years of experience in a managerial role, preferably in a multi-site organization
Clinical experience in orthopedics, pediatric burn care, and /or pediatric spinal cord injury, strongly preferred
Experience with Medicaid and Medicaid Managed Care requirements in multiple states preferred
Minimum Education Required/Preferred:
Bachelors of Science in Nursing required
Masters in Nursing or other healthcare-related field, required
Current certification in Case Management by one of the following professional certifying organizations (or agreement to successful achieve certification within 6 months of hire) required:
Commission for Case Management Certification (CCM)
American Case Management Certification (ACM)
American Nurses Credentialing Center (ANCC)
Case Management Administrator Certification (CMAC)
American Board of Quality Assurance and Utilization Review Physicians (ABQAURP HCQM) Sub Specialty certification in Case Management
Knowledge, Skills, and Competencies:
Understanding of business planning including data analytics, statistics, budgeting, leadership, communication, negotiating time management, priority setting and project management skills
Knowledge and demonstrated success applying principals of change management
Demonstrated ability to plan set and accomplish multiple objectives while leading change and effectively managing conflict
Attentiveness to detail, exhibiting self-direction, high degree of independence, judgement and discretion.
Demonstrated teaching ability using principals of adult learning, effective oral and written communication skills.
Demonstrate ability to work effectively with others as a team member and the leadership skills to develop and execute system-wide initiatives
Ability to establish and maintain effective working relationships with internal and external stakeholders at all levels across the healthcare delivery system.
Prior experience with Cerner Acute Care Management and Cerner Powerchart and Business Objects, McKesson Interqual and Mede Analytics preferred.
About Shriners Hospitals for Children
Shriners Hospitals for Children has a mission to:
Provide the highest quality care to children with neuromusculoskeletal conditions, burn injuries and other special healthcare needs within a compassionate, family-centered and collaborative care environment.
Provide for the education of physicians and other healthcare professionals.
Conduct research to discover new knowledge that improves the quality of care and quality of life of children and families
This mission is carried out without regard to race, color, creed, sex or sect, disability, national origin, or ability of a patient or family to pay.