Director - Care Management

Responsibilities

• Responsible for the daily oversight, results, and management of case management, clinical documentation specialists, social services, and utilization review staff.
• Responsible for compliance with regulatory, accreditation, payer and other standards in case management, social work and affiliated activities as appropriate for a complex health care organization.
• Serve as the lead organizational resource in discharge planning and transitional care.
• Foster, lead, and direct relationships between community and hospital based providers for seamless continuity of care of patients, including but not limited to physician offices, clinics, hospices, skilled nursing facilities, home health agencies, LTACs, and other post-acute care community agencies and facilities.
• Recognize the Planetree philosophy at Stamford Health.
• Develop programs and have processes in place to anticipate the needs of patients and families, standardizing the approach to communication and processes to improve outcomes and satisfaction.
• Develop focused initiatives to accomplish the specific objectives of the Care Management Department as well as the overall goals of the Stamford Health System.
• Collaborate with palliative care, hospice, hospitalists and other providers in the care continuum to maximize effectiveness of the team.
• Support clinical (nursing and physician) activities by working with the care management staff and intervening with medical staff members as necessary.
• Ensure that Stamford Hospital receives all payments that it is entitled to for patient treatment through active advocacy and appeal.
• Diligently appeal concurrent and retrospective denials both verbally and in writing through the resources in the department.
• Collaborate with Clinical Chairs, Division Directors, Medical Directors and administrative leaders to continue building systems and processes to improve medical management, including participation in the development of pathways, protocols, and referral management processes.
• Provide ongoing education to leadership, medical staff, and residents, on care management.
• Provide leadership for application of evidence based practices for management, aggregation, and analysis of care coordination, quality and safety data involving publicly reported data, data registries, and institution-specific variables as agreed with the VP Quality.
• Lead and participate in efforts to redesign care management, and develop alternative care delivery and reimbursement models.
• Participate in and procure externally funded care management efforts.
• Develop and manage Department and Program budgets.
• Develop and manage scorecards and performance reports in care management.
• Recruit, lead, develop, maintain, evaluate, and discipline care management personnel as necessary.
• Evaluate and recommend changes to IS systems pertinent to care management.

Qualifications/Requirements

• Current or pending Connecticut Registered Nurse, Social Work, or Nurse Practitioner License.
• Bachelors Degree in a related field is required.
• Masters Degree required (in Healthcare Administration preferred).
• Certified Case Manager (CCM) or certification in care management related discipline.
• Excellent organizational, communication, interpersonal and public speaking skills are required.
• High level of competency with MS Office and health information technology.
• Experience with personnel management in including recruitment, job description development and disciplinary processes, is required.
• Experience with developing, administering, and monitoring budgets is required.
• A minimum of five years recent experience in complex case management, long term stays, including nurse-assisted case management, utilization management, and disease management.
• Prior experience working with multidisciplinary group practice and/or community based programs and facilities.
• Experience in translating objective and measurable data into effective written and verbal communication.
• Prior training experience such as performing in-service training is preferred.
• The ability to evaluate and perform data analyses using Microsoft Excel or equivalent is required.
• Prior Hospital / Health Care required and experience collaborating with physicians and nurses is preferred.
• Independent, innovative, decision maker.
• Creative approach to resource management, financial, and human capital.
• RAC Certification or RAC Certification eligible is preferred.