INTERIM EXECUTIVE DIRECTOR 

CARE COORDINATION

​

Location: Northern California

Job Description:

Under the direction of the Vice President of Care Management, manages the day to day operations of Care Management across all multiple facilities and Care Transition programs.

 

Key Qualifications:

• Required Education: Master’s degree in Nursing or Master’s degree in Social Work or Welfare

• Required Experience: Seven to ten years of case management or quality experience and progressive management leadership experience in a large healthcare organization required.

• Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California or valid license as a Clinical Social Worker issued by the State of California Board of Behavior Science Examiners;

• Active Basic Life Support Certification

• CPI -Crisis Prevention Intervention Training 

• Preferred Licenses/Certifications: Certification in Case Management, CCMC or ACM.

• Fluency in the compliance and regulatory standards governing health plans and patient care.

• Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA & all other applicable federal/state/local laws & regulations

• Exceptional interpersonal skills required for connecting with patients and their families as well as successfully interacting with colleagues, internal physicians and staff, referring physicians and community organizations.

• Knowledge of standardized Interqual® or Milliman Care Guidelines.

• Experience with Electronic Health Record (EHR) and Case Management applications, e.g. Midas or3M.

•  Knowledge of program planning and evaluation techniques and strategies.

​

Key Responsibilities:

• Accountable for Patient Care Coordination activities including system-wide Case Management, Care Coordination and Discharge Planning. 

• Aligns Case Management with organizational strategic and operational objectives.

• Optimizes efficient Care Management/care coordination roles and processes; initiates process improvements.

• Develops, monitors and evaluates inpatient Care Management Metrics; manages the collection, analysis and presentation data relevant to the utilization of healthcare resources including but not limited to avoidable/variance days, readmissions, one-day stays, DRGs, LOS.

• Develops, maintains and implements Case Management policies, practices and procedures in accordance with CMS, CA DCHS, the Joint Commission, Title 22 and other regulatory agencies and overall hospital policies; integrates managed care contract criteria into overall Case Management functions.

• Works closely with the VP of Care Management and Physician Advisors on any audits and secondary reviews; may include but not limited to Direct and coordinate data gathering, chart audits and participants in internal and external meetings.

• Oversees educational needs and plan for inpatient Care Management division.

• Recruits, trains and coaches the management staff to assist them with performing optimally and provides appropriate discipline/structure; consults and assists Care Management managers with problem solving with staffing, personnel issues, budget issues and resource management; reviews and evaluates management staff performance, initiate personnel transactions and meet hospital standard for performance evaluations.

• Supports the VP of CM with completion of financial analyses including cost of care to reimbursement, denials management, and non-reimbursed services, promoting effective resource utilization, clinical documentation/queries quality care and patient safety; oversees the Inpatient recovery process; works closely with Revenue Cycle and Physician Advisors; regularly communicates with payors and/or their contracted vendors.

• Responsible for the coordination and support of the Utilization Review Committee.

• Responsible for overseeing patient, physician and staff satisfaction based on quality outcomes and patient experience reporting; in conjunction with the Quality Leadership, identifies utilization issues affecting the quality of patient care.

• Provides physicians, nursing and staff education including InterQual® criteria methodology, resource management, medical necessity guidelines payer sources, clinical outcome metrics, length of stay initiatives, readmission strategies, reimbursement rules and medical record documentation requirements.

• Serves as Content Expert/Liaison to community agencies, primary care provider network and all stakeholders across all system facilities (i.e. Nursing and Hospital Administrators) for provision of care and services across the continuum of care.

• In conjunction with department managers and/or supervisors, coordinates, develops, and implements action plans to respond to areas felt to be in need of improvement related to patient flow and care coordination across the continuum.

• Assumes accountability for improving utilization metrics associated with department/unit and meeting organizational/departmental targets.

• Evaluates, plans, and executes changes in department procedures, equipment and supplies