Director, Care Transitions (Full-Time, Exempt)

Enloe Health

5d • $55 - $90

About The Position

The Director is accountable for operations and the integration of all care coordination strategies for Enloe Health. The Director coordinates the design, development, implementation, and monitoring of the organization’s discharge planning functions and Care Coordination. This includes integrating services to hardwire safe, seamless transitions for patients across the continuum. The Director is responsible for guiding the staff and managers in case management and social work (both inpatient and outpatient) toward achieving clinical, financial, quality, and utilization goals through effective management, communication, and role modeling. The Director participates in program development and performance improvement and consistently demonstrates the core values of Enloe Health. The Director works closely with physicians and all departments to guide operational direction, planning and coordination of services. The Director: Participates in the development and management of department budgets and productivity targets. Manages human resources utilization, promotes employee satisfaction, supports staff development, and utilizes/supports the progressive discipline process when appropriate. Leads employees, supports organizational goals and decisions, implements necessary changes, and participates in strategic planning for service needs and resource utilization. Maintains and promotes quality service and best practice. Participates in quality improvement processes and assures implementation of regulatory standards. Ensures service is provided considering age-specific physiological, emotional, and cognitive needs of the patients served. Continually evaluates departmental function to delivery high quality care. Keeps V.P. and administration informed regarding level of care/service being provided and level of patient, employee, and physician satisfaction. Translates knowledge of professional and regulatory standards to policies, practices, and procedures and maintains to reflect current changes. Researches interdepartmental problems/issues and takes corrective action in a timely manner and promotes respectful responsive communication between departments to promote patient centered care. Provides leadership and mentorship to the managers and leads of the Case Management department ensuring optimal performance. Guides staff in the adherence to applicable standards of care/practice and/or departmental / organizational expectations. Acts as a resource to other departments for education and information in area of expertise. Implements, evaluates, and monitors care coordination services for the organization that meet clinical, financial, and regulatory requirements. Establishes, evaluates, and monitors case management processes, policies, and procedures to ensure that appropriate clinical resource utilization is achieved. Coordinates compliance with the Memorandum of Agreement with California Medical Review, Inc. (CMRI). Serves as an internal resource and consultant to management, medical staff about case management, reimbursement, clinical resource utilization and care coordination issues. Considering age-related and cultural needs, ensures that case management processes (clinical care coordination, discharge planning, performance improvement, quality/risk review, referrals to appropriate level of care) are appropriately implemented to meet patient needs by assigned staff. Communicates clinical outliers impacting financial and patient outcomes and works in collaboration with physicians, external agencies, and staff. Works with the V.P. of Nursing & the Medical Director, Utilization Management, CDI and others to problem-solve admission, referral, continued stay and other clinical outlier situations. Maintains thorough working knowledge of current professional and regulatory standards (e.g. JCAHO, Title 22, OSHA, Medicare Condition of Participation, and other state and federal agencies) and manages service accordingly.

Requirements

• Five years of hospital clinical experience
• Master’s degree in nursing OR Master’s degree in health care administration and Bachelor’s degree in nursing
• Current licensure with the California Board of Registered Nursing
• Current CPR recognition
• Accredited Case Manager, Certified Case Manager (ACM or CCM) (within 1 year)
• Knowledge of case management, care coordination and utilization review processes.
• Knowledge of regulatory requirements and quality improvement processes is necessary as well as the ability to successfully integrate these into practice.
• Must have knowledge of or ability to learn financial management and reporting, analytics and metrics, quality improvement processes, and human resources management.
• Must be able to effectively monitor, evaluate and administer the resources of Care Management and Social Work (other included resources such as Spiritual Care, etc.) and make substantiated recommendations regarding resource allocation needs for future planning purposes.
• Must be able to communicate effectively in writing and verbally both one-on-one and in groups.
• Must have the ability to lead, motivate, delegate, analyze information and problem solve.
• Must demonstrate technical competence, professional clinical judgment, critical thinking, and analytical skills.
• Principles of human resource management in the selection, placement, education, development, and supervision of staff.
• Ability to build positive working relationships with physicians and external agencies, both referral and payer.
• Excellent understanding and communication of reimbursement.
• Demonstrates evidence of strong skills in strategic planning, operational work plans, presentation skills.
• confidentiality, integrity, creativity, and initiative.
• Demonstrates ability to interact with a wide variety of individuals and handle complex and confidential-sensitive situations.
• Proficient in the use of multiple computer software programs: Microsoft Word, Excel, PowerPoint, and Internet access and use.
• Behavior should be reflective of Enloe Medical Center core values.
• Must be able to fulfill the essential functions of the position.

Nice To Haves

• Master’s Degree in Business Administration

Responsibilities

• Participates in the development and management of department budgets and productivity targets.
• Manages human resources utilization, promotes employee satisfaction, supports staff development, and utilizes/supports the progressive discipline process when appropriate.
• Leads employees, supports organizational goals and decisions, implements necessary changes, and participates in strategic planning for service needs and resource utilization.
• Maintains and promotes quality service and best practice.
• Participates in quality improvement processes and assures implementation of regulatory standards.
• Ensures service is provided considering age-specific physiological, emotional, and cognitive needs of the patients served.
• Continually evaluates departmental function to delivery high quality care.
• Keeps V.P. and administration informed regarding level of care/service being provided and level of patient, employee, and physician satisfaction.
• Translates knowledge of professional and regulatory standards to policies, practices, and procedures and maintains to reflect current changes.
• Researches interdepartmental problems/issues and takes corrective action in a timely manner and promotes respectful responsive communication between departments to promote patient centered care.
• Provides leadership and mentorship to the managers and leads of the Case Management department ensuring optimal performance.
• Guides staff in the adherence to applicable standards of care/practice and/or departmental / organizational expectations.
• Acts as a resource to other departments for education and information in area of expertise.
• Implements, evaluates, and monitors care coordination services for the organization that meet clinical, financial, and regulatory requirements.
• Establishes, evaluates, and monitors case management processes, policies, and procedures to ensure that appropriate clinical resource utilization is achieved.
• Coordinates compliance with the Memorandum of Agreement with California Medical Review, Inc. (CMRI).
• Serves as an internal resource and consultant to management, medical staff about case management, reimbursement, clinical resource utilization and care coordination issues.
• Considering age-related and cultural needs, ensures that case management processes (clinical care coordination, discharge planning, performance improvement, quality/risk review, referrals to appropriate level of care) are appropriately implemented to meet patient needs by assigned staff.
• Communicates clinical outliers impacting financial and patient outcomes and works in collaboration with physicians, external agencies, and staff.
• Works with the V.P. of Nursing & the Medical Director, Utilization Management, CDI and others to problem-solve admission, referral, continued stay and other clinical outlier situations.
• Maintains thorough working knowledge of current professional and regulatory standards (e.g. JCAHO, Title 22, OSHA, Medicare Condition of Participation, and other state and federal agencies) and manages service accordingly.

Benefits

• $0 premium medical plan to include vision insurance
• Prescription and dental group insurance
• Retirement with employer match
• Generous paid time off (PTO) plan that starts accruing immediately and can be used as it's earned
• Extended Sick Leave
• Flexible Spending Accounts for unreimbursed medical expenses and dependent care
• Employee Assistance Program
• Educational Assistance

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 1,001-5,000 employees