Director, Clinical Care Mgmt

Job Summary : The Director, Clinical Care Management is responsible for operational activities of the WMCHealth Network Clinical Care Management Program for both Medical and Behavioral Health.

Assumes a leadership role of the WMCHealth Network Clinical Care Management Program to achieve the highest quality clinical and resource outcomes.

Oversees, coordinates and monitors all Case Management team clinical and nonclinical team activities to facilitate integrated proactive utilization management.

Performs Case Management functions through coordination of care and service of patients across the health care continuum.

Promotes quality of care, medical necessity, appropriate lengths of stay and utilization of resources according to nationally accepted MCG Clinical Care Guidelines.

Responsibilities :

• Identifies and supports implementation of processes that support efficient patient through put across the WMCHealth Network Clinical Care Management model resulting in optimal clinical outcomes, appropriate use of resources and appropriate reimbursement.
• Maintains current knowledge in the field through the review of literature and develops processes and protocols to facilitate use of that information as appropriate with staff.
• Conducts Quality Metrics and Data Review Analysis. Complies with the county, state and federal regulations as it pertains to the Case Management Department.
• Oversees staff activities to ensure compliance with regulatory and accrediting standards.
• Develops and implements strategies across the WMCHealth Network to reduce length of stay and improve utilization and resource management for hospital patients in both medical and behavioral.
• Develops and implements policies and procedures for Case Management across the WMC Health Network. Participates in interdisciplinary performance improvement teams and provides education and support to other areas regarding case management services.
• Demonstrates appropriate clinical knowledge in order to assist physicians in providing complete documentation of severity of illness and intensity of services according to MCG Clinical Care Guidelines in order to assure that criteria for correct Levels of Care are met.
• Collaborates with the physician advisor to bring educational support of MCG Clinical Care guidelines to the Case Management and Medical Staff.
• Acts as a resource to other departments in developing greater awareness of utilization management MCG Clinical Care Guidelines.
• Manages and evaluates team members in the performance of various case management activities.
• Works to ensure adequate staffing and service levels, develops processes and protocols to ensure appropriate departmental function.
• Works to ensure adequate staffing and service levels, develops processes and protocols to ensure appropriate departmental function.
• Conducts regular monthly staff meetings, assists with selection, orientation and mentoring of new team members, assists team members in improving skills, creativity and problem solving.
• Conducts performance evaluations in a timely manner, provides coaching, counseling and employee development.
• Recognizes exceptional employee performance, completes quality audit reviews for all Case Management staff.
• Performs any other duties as assigned.

Qualifications / Requirements :

Experience : 5 years health care; 2 years UR / Discharge Planning, Case Management, Behavioral Health and / or related field;

current knowledge of Federal and State acute care regulations, required.

Education : RN, BSN or Masters, CCM Certification preferred.

Licenses / Certifications : Current NYS RN license, required.

Other : Clinical competency; excellent verbal and written communications skills; strong organizational, problem solving skills;

project management experience; basic computer skills.

PI242179712