Director Care Management

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The director of care management is responsible and accountable for the operation of the care management program. The components/roles of the care management program consist of the following: care facilitation, utilization management, care management, discharge planning, and transitions of care.

The director is responsible for developing systems and processes for care/utilization management at the hospital level. In addition, the director is responsible for managing the department's activities related to discharge planning and clinical quality improvement.

The director evaluates and ensures that hospital resources are used appropriately and effectively. The director oversees the collection, analysis, and reporting of financial and quality data related to utilization management.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1.Bachelor of Science Degree in Nursing.

2.Current unencumbered licensure with the WV Board of Registered Professional Nurses, or appropriate state board where services will be provided, as a registered professional nurse OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).

EXPERIENCE:

1.Seven (7) years of registered nursing experience with three (3) years of management experience.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1.Care Management Certification upon hire or obtained within 1 year of hire.

EXPERIENCE:

1.Experience with InterQual and MCG criteria.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.

They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1.Plans, directs, and supervises all aspects of the care management program.

2.Facilitates growth and development of the care management program consistent with hospital philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, and other activities as needed.

3.Provides leadership focus for coordination and facilitation of care transitions across continuum of care.

4.Responsible for creating the operational and capital, budgets. Works with manager to track and administer

5.Responsible for identifying and achieving optimal outcomes via the care management process

6.With the manager, responsible for departmental personnel functions and performance management

7.Acts as liaison to facilitate communication and collaboration between all care partners (e.g. physicians, hospitalists, community care managers, nurses, community resources, etc.).

8.Responsible for leading a high-performance team of "system thinkers" who incorporate leadership principles and vision in performing the functions of care management

9.Uses data to drive decisions, plan, and implement performance improvement strategies for care management.

10. Responsible for overseeing the education of physicians, managers, staff, students, patients, and families related to the care management process. Participates in this evolutionary process by constantly identifying future needs of current customers and/or identifying potential new customers.

11. Accountable for the assessment, planning, design, implementation, and evaluation of care management, social services, and transitions of care programs across the continuum.

12. Work closely with post-acute providers to review readmission data and the transition of care process

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SKILLS & ABILILTIES:

1.Demonstrated effective working relationship with physicians.

2.Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.

3.Knowledge of leading practice in clinical care and payer requirements.

4.Self-motivated, with proven communications skills.

5.Working knowledge of the concepts associated with performance improvement.

6.Knowledge of payer mechanisms, clinical utilization, discharge planning and transitions of care.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

UNTWN Uniontown Hospital

Cost Center:

500 UNTWN Administration

Address:

500 W Berkeley Street

Uniontown

Pennsylvania

WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.