Director, Hospital Care Coordination and Discharge 8/14/2016
JOB DESCRIPTIONAPPLY The Director of Care Coordination is responsible for the planning, assessing, monitoring and managing of the patient continuum of care. An important goal of care coordination is to ensure that patients receive quality care in the most cost-effective manner. In partnership with physician leadership, this position will ensure review of all patients admitted to plan Hospitals for appropriateness of admission; admission to the appropriate level of care status; length of stay consistent with medical and/or surgical criteria and ensures appropriateness review for services provided. The Director of Care Coordination serves as a regional resource for the care coordination team and other departments. This position contributes toward the overall development of programs and services to provide for the needs of members, physicians and staff. Assists Leadership team in providing strategic leadership to ensure equitable distribution of resources and delivery of high quality, cost-effective healthcare and efficient management of staff in accordance with goals, objectives, policies, and applicable regulatory agency rules and regulations.
* Directly and through subordinates, plans, organizes, directs, and controls the operation of the Care Coordination department (e.g., general administrative, patient care, professional services and/or a combination of these and other services). Contributes toward the overall development of programs and services to provide for the needs of members, physicians and staff. Provides strategic leadership to management to ensure equitable distribution of resources and delivery of high quality, cost-effective healthcare and efficient management of staff in accordance with goals, objectives, policies, and applicable regulatory agency rules and regulations.
* Responsible for the day-to-day operations by facilitating the development, implementation and monitoring of service, quality and utilization standards; continually evaluating and improving the delivery of service by initiating and promoting best practice models. Engages physicians and staff in problem-solving. Oversees the development of and maintains expert level of knowledge and skills related to availability of and criteria for regulatory requirements and industry guidelines for utilization management and ordering of, brokering for, and assertive advocacy for the patient and family as well as the health care system in all matters of optimal use of health care resources. This includes acting on behalf of the member to ensure they are informed and understand their appeal rights and processes if they disagree with a health care determination.
* Plans, directs, staffs, organizes and evaluates service and/or care delivered by staff. Develops, monitors, and controls payroll, non-payroll, and capital budgets and expenditures for assigned service areas. Hires, fires, performs corrective actions, employee training and development, and conducts performance assessments for assigned staff.
* Directly and with subordinate managers, establishes and maintains operational and performance standards. Monitors and evaluates the overall system of service delivery in terms of ability to meet established targets. Develops short and long term plans to improve service level of department efficiency for each area managed.
* Develops and administers appropriate policies, standards, practices and procedures; with subordinate managers, establishes goals and objectives for each department; assures compliance with administrative, legal and regulatory requirements of the Health Plan Contract and government/ accrediting agencies. Works with management chiefs, and physicians-in-charge to identify and establish programs and practices which are cost effective and provide quality service to members, staff and physicians. Provides education and program development functions to ensure systematic and ongoing contact with hospital staff/other departments (CCS, LTC, Expanded Care, DME, HH, and Hospice) to share information regarding care coordination role and ongoing responsibility for acute care/ED patients. Provides leadership in discharge planning with hospital personnel to develop and implement policies and procedures related to patient transfers across care settings.
* Contributes to effective and accurate communications, operations, and planning by conducting studies and reporting findings, and participating in special committees and/or projects.
* Participates in community relations activities to enhance the image and reputation of the organization in local customer service areas. May represent the organization in activities involving leaders in business, government, labor, the community at large, Health Plan Members and healthcare providers in the area.
* Minimum of five (5) years management experience in Care Coordination, Discharge Planning, and Case Management with progressive accountability in a complex, multi-faceted healthcare setting and in working with a large physician group practice managing through influence and collaboration.
* Minimum of three (3) years experience in financial management, budget development, program development, quality improvement and project management.
* Hands on experience with Care Coordination, Discharge Planning, and Case Management.
* Bachelor's degree in healthcare, nursing, or social work, or public or business administration, or related field.
License, Certification, Registration
* RN or Social Worker preferred