Director of Care ManagementRequisition R095332 Market Paducah, Kentucky Department SS Quality - Care Management Shift Days Schedule Full-time
Thank you for considering a career at Bon Secours Mercy Health!
Responsible for directing, planning, organizing, and managing functions and resources for the Care Management Department. Works closely with Care Management Leadership and colleagues to implement leading practices that support a progressive, data- driven, outcomes-oriented care management model. Fosters integration and strong collaborative partnerships with nursing, quality, hospitalist, and market/facility leadership related to clinical integration activities in order to optimize high quality, cost- efficient care in a timely manner that is patient focused and seeks to improve the experience of care.
Essential Job Function
- Collaborates with CM leadership and colleagues to achieve leading, standardized practices and processes related to: Care Transition management including readmission prevention. Use of predictive readmission tool and application of appropriate interventions. Length-of-stay management. Advance Care Planning. Denial prevention related to medical necessity through proactively addressing barriers to Care Transitions (including tracking of avoidable days/delays to identity opportunities). Daily team rounding- IDRs. Patient satisfaction and experience related to Care Transitions
- Responsible for tracking and monitoring of department performance. Responsible for departmental results and implementing action plans for continuous improvement
- Supports national standards for care management scope of service: Education, Care Coordination, Compliance, Transition Management and Resource Utilization. (American Case Management Association, ACMA)
- Works closely with community health, ambulatory and population health partners in efforts to support patients across the care continuum. Collaborates with ambulatory and post-acute providers/staff to ensure seamless transitions of care. Works closely with post-acute network partners on key initiatives and efforts to reduce unnecessary PAC utilization, when safe and appropriate
- Partners with facility physician leader to optimize the Utilization Management Committee, providing actionable data related to utilization opportunities identified through qualitative data, and quantitative data analytic platforms such as Quality Advisor, and other facility and system data resources.
- Collaborates with our Ensemble partners to support denial prevention, patient classification and compliance for optimal performance and adheres to SOW related to BSMH responsibilities.
- Directs daily operations to achieve effective utilization of personnel resources consistent with patient and ministry needs. Directs development of annual departmental goals and objectives, aligns with system CM goals and objectives.
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- Ensures compliance with federal, state, and local regulations and accreditation requirements impacting care management service. Routinely audits and tracks for quality assurance, analyzes data to identify opportunities for performance improvement. Holds staff accountability to follow CM processes to support quality, resource utilization and compliance.
- Required Minimum Education: Bachelor's Degree in Nursing or Social Work
- RN License OR Social Work Certification (MSW) Required. Certification in Care Management preferred within 3 years of hire.
- 3- years acute hospital care management experience preferable in a leadership role.
- Teambuilding skills and training / coaching staff to meet operational requirements and goals.
- Highly self-motivated, organized and detailed oriented with an attitude for continuous improvement.
- Proficient with computer software programs, including Microsoft Word, Excel, PP and Electronic Health Records.
- Experience with practices and methodologies related to care management.
- Critical thinking skills necessary to effectively resolve human, technical and/or managerial problems.
- Effective leadership and communication skills to lead a diverse team.
- Excellent customer relations skills – internal and external.
- Fosters and promotes proactive behavior team- based, collaborative care from all members of the healthcare team.
- Takes initiative to educate self and staff on CM practice, landscape of changing healthcare, etc.
Bon Secours Mercy Healthis an equal opportunity employer.
We’ll also reward your hard work with:
- Comprehensive, affordable medical, dental and vision plans
- Prescription drug coverage
- Flexible spending accounts
- Life insurance w/AD&D
- An employer-matched 403(b) for those who qualify
- Paid time off
- Educational Assistance
- And much more
Scheduled Weekly Hours:40
Department:SS Quality - Care Management
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email firstname.lastname@example.org. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at email@example.com.
I wanted to get into a career where I’m happy to go to work.Luis F. Registered Nurse