Director, Care Management

$120,000 - $160,000/Yr

Saratoga Hospital - Saratoga Springs, NY

Full-time

Saratoga Springs, NY

Hospitals

About the position

The Director of Care Management is responsible for governance and leadership of the Care Management Department. The Director is responsible for the effective functioning of the Care Management Department and Utilization Management for Saratoga Hospital, coordinating high-quality, cost-effective patient care. Collaborates with all disciplines to develop and implement care management methods, outcome measures, quality patient outcomes and appropriate utilization of resources at Saratoga Hospital.

Responsibilities

• Responsible for providing leadership to personnel; provides feedback to team members and staff concerning their performance.
• Establishes systems for open communication and problem solving and promotes professional growth and development in self and others.
• Develops departmental policies and procedures, in collaboration with other colleagues.
• Identifies areas for improvement, and implements changes as needed.
• Collaborates with other department leaders to ensure efficient and effective operations.
• Prepares, implements, and monitors the operating and capital budget adjusting as conditions change.
• In collaboration with nursing colleagues, develops departmental and divisional policies and procedures to assure that nursing care reflects current professional standards and practice.
• Works collaboratively in continuously monitoring and evaluating all clinical and administrative operating systems to ensure that the necessary elements are in place to maximize the quality, efficiency of the patient service cycle and provide for an optimal patient encounter.
• Leads and directs all care management activities, ensuring patient care coordination and adherence to clinical protocols and regulatory standards.
• Develops and implements care management programs, management protocols, policies, and departmental strategy in consultation with senior leadership.
• Supervises a multidisciplinary team of care managers responsible for patient care coordination.
• Utilizes the Electronic Health Record to document seamless care coordination across medical services, including transfers, transitions, and referrals.
• Partners with medical and professional staff to promote organizational stewardship of healthcare resources.
• Ensures appropriate care progression and transition through concurrent review.
• Coordinates case reviews regarding levels of care, length of stay, resource utilization and avoidable delays.
• Assists medical and professional staff with education regarding DRG LOS, denials, clinical documentation, practice guidelines within the EMR and any regulatory changes.
• Drives performance improvement by sharing specific data regarding LOS, readmissions, use of hospitalist program, and case denials.
• Ensures compliance with CMS conditions of participation and managed care contracts, participates in Medicare audit reviews, and participates in the appeals process.
• Maintains a working knowledge of applicable national, state, and local laws & regulations, Joint Commission, DNV, NCQA, and other regulatory agencies.
• Actively participates in the creation of clinical quality improvement activities including the use of technology and clinical informatics, as it pertains to utilization and care management.

Requirements

• BS/BSN required, MS/MSN preferred or working towards.
• National certification in Nursing Administration and/or Case Management preferred.
• Minimum of 5 years relevant clinical experience.
• Minimum of 3 years in clinical leadership positions with progressive leadership responsibilities.