Director Case Management

Riderwood, MD, United States

Job Description General Summary

The Director's primary responsibilities include management of all case management from pre-admission through post-discharge associated with the University of Maryland, St. Joseph Medical Center inpatient units, specialty outpatient units and emergency department. This position has responsibility for daily operations management and

leadership in strategic planning/implementing case management, utilization management and social services. This position has direct reports including Manager of ICM, Team leads, office staff and dotted line Physician Advisor. In addition, this position works closely with physician and nursing leadership within the hospital setting and along the healthcare continuum. The position is accountable for budgeting and financial performance, patient satisfaction, human resources management, process improvement, and overall patient flow/ LOS management. The position will ensure consistency in management of workflows, documentation, quality and outcomes for case management. Provides oversight to development and implementation of innovated processes to improve clinical outcomes.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Strategic Leadership

Develops and implements short- and long-term goals and objectives to achieve overall University of Maryland St Joseph Medical Center goals.

Engages with Revenue Cycle management, including Chief Financial Officer, Revenue Cycle.

Director, managed care contracting, denial management, HIM and billing to ensure coordination of efforts through the revenue cycle.

Prepares annual strategic plan to include goals and action plan for Case Management Department across inpatient and outpatient setting to meet annual targets for LOS, cost of care, readmission rates and related quality metrics.

Creates accountability and escalation pathways for resolving Care Coordination issues throughout Medical Center.

Utilizes knowledge of hospital process, clinical patient care, state and federal regulations and payer requirements to participated and guide leadership of interdisciplinary teams towards improvement of patient flow, clinical outcomes and efficiency.

Maintains knowledge of current economic trends, legislation and policy at state and federal levels, JACHO and CMS requirements.

Maintains positive working relationships with medical staff, department chairs, medical directors and physicians.

2. Performance Management and Workforce Engagement

Oversees and directs the work of the Clinical Case Managers, Utilization Case Managers and Social workers.

Analyzes, evaluates and recommends operational efficiencies, process design and organizational structure that enables the Medical center to optimally provide services.

Objectively measures efficiencies, productivity, quality and cost. performance to identify and track departmental performance.

Provides consultations/direction to individuals and/or teams to facilitate compliance.

Utilizes data to target opportunities for continuous improvement.

Recruits, interviews, hires and on-boards new management staff. Provides direction and evaluates departmental workload and responsibilities. Collaborates with Human resources leaders.

Handles conflict and resolution of conflict in timely and appropriate manner.

Promotes diversity, equity and inclusivity in the workplace and care coordination process.

3. Fiscal and Resource Management

Maintains accountability for meeting established financial performance metrics for assigned departments.

Works collaboratively with department leadership to plan, develop, implement and monitor all financial activities of the department.

Submits operational and capital budgets for case management, monthly financial performance indicators, approves expenditures for supplies and service as necessary.

Identifies and ensures appropriate resources to achieve department goals.

Participates in negotiations regarding adding or renewing medial necessity critical decision support tools and related software applications and implementations.

Analyzes utilizations financial resources to forecast needs, project cost, investigate trends and variances.

Prepare statistical data and reports.

4. Additional duties as assigned or directed

Company Description When you come to the University of Maryland St. Joseph Medical Center, you're coming to more than simply a beautiful 37-acre, 218-bed suburban Baltimore, Maryland campus. You're embarking on a professional journey that encourages opportunities, values a team atmosphere, and makes convenience and flexibility a priority. Joining our team of healthcare professionals means you'll be contributing to a locally and nationally recognized institution. UM St. Joseph has been recognized by The Leapfrog Group as a grade 'A' hospital and by U.S. News & World Report as #3 in both the state and Baltimore Metro area, making UM St. Joseph the highest-ranking community hospital in Maryland. In addition, we've been consistently recognized as a top employer by Baltimore magazine.

Qualifications Education and Experience

1. BSN, MSN preferred and/or Master of Social Work required.

2. RN license required in States of Maryland or LISW-S in Maryland.

3. Minimum 5 years management experience to include considerable experience in care coordination, leadership, coaching and mentoring.

4. 7-10 years of progressive case management experience required.

Certifications & Licensures

1. ACM or CCM required (or willing to obtain in 1 year)

2. RN or LISW-S

Knowledge, Skills & Abilities

1. Ability to communicate clearly with patients, visitors and staff of the Medical Center.

2. Concentrate and pay attention for periods of up to 8 hours to perform such tasks as personnel management, data analysis, strategic planning and problem solving.

3. Solve complex problems and deal with variety of variable in situations where only limited standardization exists.

4. Interpret a variety of instructions furnished in written, oral, diagram or schedule form.

5. Ability to read, analyze and interpret common scientific and technical journals, financial reports and legal documents.

6. Ability to define problems, collect data, establish facts and draw valid conclusions.

7. Ability to respond to common inquiries and complaints from customers, regulatory agencies or members of the business community.

8. Utilize standard business equipment.

Additional Information All your information will be kept confidential according to EEO guidelines.

#J-18808-Ljbffr