Description
THE ROLE
The Executive Director of Case Management is responsible for leading, setting strategic direction, coordinating and supporting care management activities for the North Division inpatient care management functions. The Executive Director works collaboratively with inter-professional teams of clinicians across the continuum. The Executive Director works in partnership with Medical, Nursing, Quality, Program, Home and Community Services, Puget Sound Physician Enterprise, Utilization Management, and external partners across the state to achieve optimal patient care, attainment of financial goals and development of leaders. Approximately 80% of this role is directed toward advancing inpatient Clinical Care Management (CM) practice and 20% toward improving cross-continuum coordination.
In collaboration with the Puget Sound and Alaska Physician Enterprise, the Executive Director is responsible for strategic leadership and initiatives to improve population outcomes related to clinical outcomes and the total cost of care.
This position has accountability for inpatient (IP) care management services to include care coordination, social work, transition planning, and the management/oversight of the Patient Charity Fund and Complex Case/Long Length of Stay meetings at each hospital. The Executive Director has direct reporting and management responsibility for the inpatient Care Management and UM departments at all hospitals in the Puget Sound and Alaska Regions.
The Executive Director is responsible for managing and enhancing relationships and services in the community who care for patients outside the acute care setting (this includes homecare, long term care, skilled nursing facilities, adult homes, medical homes, clinic, shelters and centers for homeless and populations with limited resources). Develops relationships with the payer community and identifies opportunities to collaborate in utilization management and discharge planning. Responsible for leading the organization to implement and sustain predictable plans for patients during the continuum of care from pre-admission to discharge.
Serves as expert in utilization review and management. Supports the Utilization Management Committee according to the responsibilities outlined in the Utilization Management Plan. Collaborates with the Medical Director of Utilization Management to identify utilization trends. Works closely with financial department in denials management.
Studies on an ongoing basis national and regional trends and adjusts the case management model to meet financial, regulatory and clinical quality goals for the North Division. Develops, monitors, and reports metrics to demonstrate department effectiveness and value to the organization.
ESSENTIAL FUNCTIONS
Provides leadership and strategic planning to operationalize standard care management services and develops a coordinated approach to care management across the continuum, including the development of a post-acute care strategy for the Puget Sound and Alaska regions.
Oversees regional development of goals, creation and implementation of action plans and program/intervention evaluation.
Facilitates collaboration and coordination among all regional entities to develop and facilitate best practice(s) in care management and care coordination. Leads, charters, and participates in region-wide care management teams.
Actively collaborates with Utilization Management, Providers, and the delivery system to develop clinical strategies to reduce admissions that do not meet medical necessity; to reduce LOS; to improve transition planning; and to reduce denial rates. Assures that each PSR and Alaska regional hospital has an effective Complex Care/Long Length of Stay forum.
Oversees all activities related to referral management. Develops collaborative relationships with payers and maintains compliance with payer contracts for utilization management.
Facilitates the delivery of safe, high quality care through clinical and non-clinical care management/coordination, ongoing process evaluation, and reviewing clinical outcome metrics.
Has direct reporting responsibility for IP care management departments at the PSR and Alaska region acute care hospitals. Works with division CMO and CNO to evolve the organizational model. Accountable for both the clinical and the financial management of designated care management areas. This includes the development, implementation and monitoring of annual capital/operating and personnel (FTE) budgets. Provides support and education to department managers for meeting clinical and financial goals. Collaborates with facility CNOs and CEs to develop Case Management budgets that support program goals.
Responsible to continuously evaluate and advance the inpatient Clinical Care Management model assuring best use of RN, SW and non-professional staff skill sets; proactive identification of and intervention with patients; continuity of assignments whenever possible and adequate Care Manager and Social Work coverage for all inpatient and Emergency Department settings. Collaborates with leadership in all inpatient and Emergency departments to evolve the CM model to meet patient needs.
Develops strategies to leverage resources to advance professional growth, spread best practices, and provide flexible staffing options. Convene, lead and/or monitor regional work groups as indicated to address opportunities.
Identifies and acts upon opportunities to appropriately coordinate services between inpatient, outpatient and community settings. Forms community relationships and works to identify gaps in the continuum of care. Understands and promotes the use of community resources to improve the patient experience. Promotes and maintains positive relations with continuum of care providers.
Ensures that all aspects of federal, state, local and The Joint Commission/DNV compliance care management related criteria are met.
Measures, analyzes and reports key metrics related to care management across the care continuum. Obtains, utilizes and leverages existing data for improvement of patient flow and other key performance indicators. Facilitates development and distribution of reports.
Models and fosters an environment of professionalism and compassionate care. Guides the recruitment, retention, and employee engagement that keeps high performers in place and maintains focus on succession planning. Acts as a role model through the demonstration of personal professional development, continuous learning and competency improvement.
Partners with Physician Enterprise and Clinical Services operations to become more efficient and effective in achieving total cost of care objectives, in alignment with clinical quality and access objectives.
Serves as liaison for statewide care management-focused initiatives and for project related activity within Providence Health Systems and within the North Division.
Provides on-going communication to key stakeholders to ensure the required support is provided for initiatives to be successful and identified issues to be addressed.
Influence information technology solutions at Regional, Division, and System level to support cross-continuum care management and coordination (i.e., Epic functionality, Emergency Department Information Exchange system).
Identifies and implements best practices related to: Clinical Care Management, Utilization Management, Chronic Disease Management, Health Promotion, Care Transitions and Transition Planning, Post-acute Services, Social Work, Hospital Throughput, Patient Placement, LOS Management, and other related areas as indicated.
Improve our ability to appropriately measure the impact of care models and interventions on individual and population health objectives and guide resource allocation.
Develops strategic priorities, tactics, business plans, and budgets as required.
Manages care management software and contracts. Identifies and acts upon the need for software tools to support effective care coordination. Collaborates to optimize use of existing tools
Provides key stakeholders (directors/managers, staff, physicians, community) education related to regulations/requirements or best practices. Increases knowledge of CM functions through new employee orientation by assuring care management content is continuously updated and regularly presented.
EDUCATION
Bachelor's Degree in Nursing
Master's Degree in Nursing or Business Administration
OR
Master's Degree Social Work from an accredited school
EXPERIENCE
10 years Leading Case Management in a Complex Hospital System.
Experience in progressively responsible roles with demonstrated leadership experience and strong team management skills.
Experience working with physicians.
JOB SPECIFIC KNOWLEDGE, SKILLS and ABILITIES
Case management concepts and strategy.
LICENSES and CERTIFICATIONS
Required upon hire: Washington Clinical Independent Social Worker License (Vendor Managed)
Preferred upon hire: ACM or CCM Certification
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
Requsition ID: 143243
Company: Providence Jobs
Job Category: Care Management
Job Function: Clinical Care
Job Schedule: Full time
Job Shift: Day
Career Track: Leadership
Department:
Address:
Pay Range: $65.74 - $118.78
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
