Director of Care Management / RN Licensed:
Competitive Compensation, based on experience.
Excellent Benefit Package
Location: Geneva, NY (Finger Lakes Region)
(Ability to Travel the short drive from Geneva to Penn Yan)
Reports: Chief Medical Officer
Department: Care Management
Supervises: CARE MANAGER, RN UTILIZATION REV, SECRETARY, SOCIAL WORKER MSW
Education: Master’s in Social Work, Business or Nursing required.
License: Current NYS RN license required
*Must have Acute Care Experience*
Experience: Minimum: Five years’ experience in a healthcare setting. Three years’ experience in utilization management or denial management. Knowledge and experience in developing utilization management and revenue recovery strategies. Experience dealing with authorizations and appeals process. Knowledge of discharge planning and clinical case management strategies. Knowledge and experience in project management and team dynamics. Knowledge of and experience with basic research methods and statistical analysis. Preferred: DRGs, Medicare Regulations, Medical Necessity Criteria, Patient Bill of Rights, HIPAA.
Responsibilities: Supervises professional and clerical employees who work with a range of functions, including but not limited to access, pre-authorization and precertification, bed placement, coding, utilization review and denial management, care coordination collaborative treatment planning and core measures, discharge planning, clinical social work, tracking of the post-acute period and provision of disease management, and contracting internally and externally. 2. Partners with the CMO for effective relationships with physicians, services, specialties, etc. 3. Provides consultation to the executive team, forming effective relationships with all VPs and department leaders. 4. Participates in the determination and definition of the Care Management Dashboard, using data to better understand strengths and weaknesses of the department, and to determine needs, decisions, and strategies. 5. Establishes, implements, and evaluates a written strategic plan for the department that takes into account internal and external factors. 6. Establishes, manages, and constantly evaluates staffing levels, assignments, skills, learning needs, and deployment of staff. 7. Creates stable and reliable processes to anticipate and address specific situations within the department and between the department and other departments and agencies. 8. Establishes effective communication systems and forums with third party payers, the local PRO/QIO, Medical Records, and the managed care and finance offices. 9. Develops structures and processes to facilitate participation by physicians, physical therapists, social work, and other health professionals in multidisciplinary care planning, care delivery, and discharge planning. 10. Participates in continuous quality improvement groups. 11. Negotiates, approves, and manages the operational and capital budgets. 12. Writes and conducts annual and interim performance appraisals for all staff in the department.
Ability to facilitate project management, work effectively under pressure, meet deadlines, manage multiple priorities and enhance the spirit of teamwork through effective role modeling. Familiarity with JCAHO requirements. Excellent leadership, interpersonal, communication (written and oral), analytical, and organizational skills. Demonstrated ability to deal effectively with the public in a professional and courteous manner. Computer literacy required with word processing, spreadsheets, power point.
About the area: Located in the beautiful, nature enthusiast Finger Lakes Region of New York State. It boasts quality wine trails of the Finger Lakes wine region, a rich history, natural beauty, and four-season attractions. Short drive to many area colleges and universities.