Director of Care Management

POSITION SUMMARY

Reporting to the Vice President of Population Health the Director of Care Management has 24 hour accountability for the oversight of all activities to manage the care of the patient over the continuum of care from pre hospitalization through discharge.

These activities include admission, continued, extended and discharge reviews in all reimbursement categories to determine medical necessity, assure high quality of care and efficient utilization of available healthcare resources, facilities and services.

The Director contributes to the Utilization Management Plan for the organization and coordinates variance reports and summaries with Quality and Performance Improvement, Risk Management, and Infection Control.

This role encompasses the effective and efficient management of human, fiscal and other resources, development of staff competency through assessment and education, compliance with regulatory and professional standards and strategic planning, improvement of quality, service levels, safety, customer satisfaction and of collaborative relationships.

This position requires the full understanding and active participation in fulfilling the Mission of Martin Luther King, Jr.

Community Hospital. It is expected that the employee will demonstrate behavior consistent with the Core Values. The employee shall support MLK Community Healthcare’s strategic plan and the goals and direction of the quality and performance improvement process activities.

The Director of Care Management works with the appropriate Clinical Departments, IT leadership, key hospital and outpatient operational areas, network partner institutions and administrative leadership to deploy meaningful analytics and metrics for care management IT interoperability, which supports MLKCH’s care management goals. This includes :

• Collaborating in the development of a robust clinical informatics / clinical decision support functions that informs and monitors implementation of the cross-continuum care management activities
• Developing appropriate care management dashboards, reports, and alerts
• Advocating for an accessible and compatible clinical information and informatics functionality to support optimal care management across the continuum of care

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Establishes operational plans for the Care Management Department based upon the Hospital’s mission and strategies.
• Develops and monitors labor, supply and capital budgets; sets staffing and resource utilization parameters on a daily basis.
• Evaluates FTE allotment and staff skill mix for long range staffing adjustments.
• Makes recommendations for program / service changes to increase efficiency and appropriate use of fiscal resources.
• Develops and prioritizes annual department budget in line with the Hospital's process, goals and targets based on projected volume / workload, expense dollars and revenue dollars.
• Develops, revises or reviews all policies and procedures. Has intimate knowledge of the Care Management Department policies and procedures and monitors staff compliance.
• Operationalizes human resource policies to include behavioral interviewing, credentials compliance, orienting, evaluating, coaching / counseling, disciplining and terminating staff.
• Implements a process to evaluate and improve staff competencies through education.
• Develops and operationalizes the Quality and Performance Improvement Plan.
• Serves as a resource person and internal consultant to department heads, medical staff, and hospital staff related to Care Management of the patient population served.

Ensures age-specific and population specific awareness in patient / family care and interaction.

• Utilizes Milliman, when necessary, and Xsolis best practices to determine patient disposition. Collaborates with Hospitalists, Intensivists, Laborists and Emergency Department physicians in this process.
• Organizes and directs work flow, solves intra and interdepartmental problems that inhibit work flow and quality, motivates employees to optimal performance, and serves as a resource to staff for clinical, ethical or systems issues.
• Develops department safety and disaster response plan in compliance with the Hospital's plan.
• Develops and uses a system to continuously evaluate and respond to customer concerns. Assures that the Watson Model of Care is implemented by the Care Managers.
• Participates with hospital and physician leadership in decision-making. Acts as patient care liaison with the Medical Staff.

Fosters multi-disciplinary integration of process improvement strategies.

• Acts as a resource and has oversight of staff in the Care Management Department with current knowledge of all aspects of the case management process related to the population served.
• Responsible for appropriate patient placement in the ADT processes. Assigns a Care Manager to every patient on admission to the hospital.
• Establishes accountability for MLKCH’s Case Management, Care Coordination and Discharge Planning functions, and other related functions.
• Works collaboratively with hospital and clinic based staff to help coordinate care to ensure effective and efficient delivery of services and to improve patient outcomes and reduce health care costs.
• The role directly supports MLKCH’s strategic objectives to improve the health status of the community by delivering care management, integrating with providers, payors, and community partners, and improving the overall quality of health care delivered in the community we serve.
• Other duties as assigned.

POSITION REQUIREMENTS

A. Education

Bachelor of Science degree in nursing; Master’s in Nursing, Business or related health field required (individuals without a Master’s will be required to complete the degree within 2 years of their hire date).

B. Qualifications / Experience

• Minimum of five (5) years of care management experience. Experience in managed care environment required.
• Current California Nursing license
• Certification in Case Management preferred.

C. Special Skills / Knowledge

• Bilingual language skills preferred (Spanish)
• Basic computer skills
• Current Basic Life Support (BLS)
5 days ago