Director Care Management - Full Time - Day Shift - Pittsburgh

Company :

Job Description : 

GENERAL OVERVIEW:

Provides operational and strategic leadership for Hospital/facility Care Management Department.  Collaborates with nursing and clinical leaders to assure smooth patient care progression and effective outcomes and care transitions.  Directs collaborative efforts with physicians, revenue cycle and payor teams, and patients and their families to incorporate evidence based practices and appropriate use of resources.  Communicates effectively with Hospital leadership in the development of day to day and strategic goals. 

ESSENTIAL RESPONSIBILITIES:

• Evaluates effectiveness,  leads improvement efforts, and assesses outcomes within Hospital to assure appropriate access, care progression, transition, and level of care determination practices. (20%)
• Studies and implements the care management model and structure to achieve sustainable length of stay, resource utilization, and clinical outcomes for patients over time.  Responsible for designing and implementing improvement strategies for the care model on an ongoing basis. (20%)
• Directs and oversees all activity related to referral management.  Leverages Epic and Careport/Allscripts data to assess effectiveness.  Collaborates closely with Highmark Home and Community Services to establish  and/or enhance post-acute network. (15%)
•  Analyzes clinical service areas for operational effectiveness, using dashboards and other data sources.  Monitors departmental performance against system initiatives and goals.  (10%)
• Assures that department works collaboratively with patients, families, peers, and other departments in the organization/network to meet established organizational goals for patient experience. (10%)
• Pursues sharing of best practices through publication, presentation at conferences and networking with other AHN leaders throughout the system. (10%)
• Establishes a development plan for the department, with a focus on effective use of resources, inter-professional collaboration, and coordination with chronic disease, transitional planning, and specialty teams. (5%)
• Develops and implements workflows which assure efficient care coordination and transition, Hospital throughput, and adherence  to payer requirements in order to minimize financial risk to patients and the health system. (5%)
• Lead and support evidence based projects & research by assisting in the identification of opportunities to incorporate the scientific method into practice. (5%)
• Other duties as assigned.

QUALIFICATIONS:

Minimum

• Bachelor's Degree in Nursing OR Master's Degree in Social Work
• 5 years in Complex Transition Management
• 1 year in a management or leadership capacity
• Registered Nurse OR Licensed Social Worker
• Strong communication and collaboration skills
• Problem-solving
• Resilient and agile change agent
• Microsoft office suite
• Act 34 Criminal Background Clearance Certificate.
• Act 33 Child Abuse Clearance Certificate.
• Act 73 FBI Fingerprinting Criminal Background Clearance Certificate.

Preferred

• Master's Degree in Nursing, Health Administration, Leadership or related field

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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