Director Care Transition-Fort Worth

Texas Health•Fort Worth, TX

4d•Onsite

About The Position

The Director Care Transition is responsible for the effective daily operation of the care transition function. This role involves providing and implementing strategies to improve operations and outcomes, determining proactive strategies and methods for a high-performance culture related to care transition management, and supporting change management towards interaction with outpatient care management. The Director directs the activities of Care Transition Managers (RN & SW) and serves as a content expert on various compliance, medical necessity, and psychosocial issues related to hospitalization and transition planning. This position also develops and oversees policies, procedures, and standards for care transition management, participates in developing new staffing and care designs, and ensures standards are consistent with evidence-based practice. The Director is responsible for data collection and analysis of clinical and financial data to improve performance, achieving high levels of customer satisfaction, and developing and managing the operating budget. Additionally, the Director provides overall direction and oversight to the care management function, develops an annual plan with operating metrics, provides input into strategic planning, and represents the organization with third-party payors. This role involves facilitating organizational meetings, providing educational offerings, supporting community health activities, and maintaining professional relationships with system leadership and medical staff. The Director also develops and implements strategies for a positive employee relations environment, oversees recruitment and retention, promotes professional growth, tracks staff performance, coaches staff, identifies leadership talent, and achieves high levels of employee satisfaction. Finally, the Director incorporates customer needs into operations, promotes team building, reviews customer satisfaction evaluations, and takes action to address performance gaps.

Requirements

Bachelor's Degree Nursing, or, Master's Degree Social Work required
5 years directly related experience in hospital case management, demonstrating progressive developmental and management growth inclusive of supervisory and leadership experience required
RN - Registered Nurse, or, LMSW - Licensed Master Social Worker, or, LCSW - Licensed Clinical Social Worker required upon hire
CPR - Cardiopulmonary Resuscitation required upon hire
Knowledge of industry standards related to Joint Commission, CMS, OSHA, regulatory standards for areas of responsibility.
Knowledge of continuous improvement tools and techniques such as Six Sigma, Lean, and Clinical Microsystems.
Knowledge of managed care contracting and standards, medical necessity, and precertification experience with transition issues.
Knowledge of home health, skilled nursing rehabilitation setting as related to coordination of care across the continuum.
Must be able to analyze and manage information.
Excellent verbal/presentation and written skills with the ability to communicate effectively with a wide variety of professional and nonprofessional stakeholders.
Able to supervise a diverse and independent staff.
Individual must be self-directed and goal/outcomes/measurement driven.
Must be adept at Microsoft Office suite, statistical analyses and displays of information.

Nice To Haves

Master's Degree preferred
ACM - Accredited Case Manager, or, CCM - Certified Case Manager, or, CPUM - Certified Professional Utilization Manager, or, other ANCC preferred upon hire
Preferred experience with electronic health record and automated case management systems.

Responsibilities

Responsible for the effective daily operation of the care transition function.
Responsible for providing and/or implementing strategies to improve operations and outcomes.
Determines proactive strategies and methods necessary for a high performance culture related to care transition management.
Supports change management and movement toward interaction with outpatient care management.
Directs the activities of the Care Transition Managers (RN & SW).
Serves as a content expert on compliance with program expectations, mitigation activities with all clinical partners / payors, compliance requirements (Code 44 intervention, HINN letters, Second IMM, Observation letter, etc.), potential denials, avoidable days, alternate level of care days, medical necessity criteria, patient status, and discharge criteria, all clinical and transition documentation, clinical review staff requirements and communications, psychosocial issues related to hospitalization and transition planning, Child and Adult Protective Care Services cases, Adoptions, Complex psychiatric referrals, Applications for community resource needs, Guardianship processes, Mental Health Treatment Declaration - Order of Protective Custody, Mental health court filings, and Indigent programs as appropriate.
Develops and oversees the implementation of policies, procedures, and standards that provide structure for care transition management.
Participates in the development of new staffing and care designs that support system goals while achieving best in class performance.
Supports standards are consistent with hospital, community and nationally recognized evidence based practice.
Participates in the data collection and analysis of clinical and financial data (e.g., LOS data, avoidable days, adverse determinations, and denials/appeals) and makes recommendations to improve performance.
Achieves and maintains high levels of internal and external customer satisfaction; specifically collaborates with nurses and physicians providing direct patient care and members of other disciplines and departments at all levels in the development, implementation and evaluation of programs and services.
Develops and manages the operating budget as required by THR.
Responsible for providing overall direction and oversight to the care management function to obtain expected outcomes.
Directs the activities of the organization related to Care Transition Management.
Develops an annual plan including operating metrics for dashboard.
Provides input into the strategic planning process for THR and medical staff.
Participates in appropriate THR and community forums.
Achieves positive results for the organization related to investigations of complaints requiring the Director's direct involvement.
Facilitates as lead staff at various organizational level meetings; often represents the organization with respect to third party payors and intermediaries.
Available for one-on-one meetings with a wide range of stakeholders for education/development and problem-solving.
Provides major educational offerings on new tools, techniques and approaches to a wide variety of audiences as appropriate.
Support and promote community health activities among staff and colleagues including through community initiatives.
Maintains excellent professional relationship with system and entity leadership teams.
Communicates and collaborates with the system (THR) in the areas of data and information management, performance improvement, care coordination, care transition management, medication management, and social services including THR committee participation, as well as direct interactions with leadership and staff at the appropriate THR departments with appropriate communication.
Develops and implements strategy to create a positive employee relations environment.
Supports activities to recruit, orient and retain competent staff.
Mentors job related growth of managers & staff.
Oversees the effectiveness of the department recruitment and retention program, taking action as necessary to provide an adequate level of qualified staff.
Promotes professional growth, development and accountability in staff, students and colleagues.
Tracks and evaluates staff performance and individual accountability for achieving expectations.
Coaches and mentors staff to improve their performance and continue to develop their professional skills.
Identifies leadership talent and actively develop leadership skills in staff.
Achieves and maintains high levels of employee satisfaction.
Establishes and maintains professional relationship with medical staff on related issues.
Orients medical staff on care transition management principles.
Escalates issues to Physician Advisor as appropriate.
Develops annual capital and operational budget.
Monitors compliance of same.
Considers clinical, quality and operational outcomes and financial implications when making recommendations for changes in practices/operations.
Evaluates use of newly developed technology or products for cost effectiveness.
Reviews budgets and justifications.
Develop action plans that addresses variances (positive and negative) as needed.
Utilizes management reports to evaluate budget and staffing variations.
Resolve daily staffing issues as needed.
Incorporates customer needs and expectations into daily operations and business planning strategies.
Promotes team building strategies and principles of group process in interaction with staff.
Reviews customer satisfaction evaluations on a regular basis to determine gaps between actual and expected performance.
Takes appropriate action in conjunction to remedy actual vs. expected performance gaps in a timely manner.
Discusses patient, staff, physician, and other department complaints.