Description:

DIRECTOR OF CARE MANAGEMENT  Geneva, New York
  Education Requirements
Masters in Nursing
Licensure
Required: Current New York State Registered Professional Nurse licensure.
Experience
Five years of Care Management hands on  Leadership experience in a Hospital setting. Three year experience in utilization management or denial management. Knowledge and experience in developing utilization management and revenue recovery strategies. Experience dealing with authorizations and appeals process. Knowledge of discharge planning and clinical case management strategies. Knowledge and experience in project management and team dynamics. Knowledge of and experience with basic research methods and statistical analysis. Up to date clinical skills. The ideal candidate will be a Servant Leader.

Reports to
Chief Medical Officer

Supervises
Care Manager, RN UR, Secretary, Social Worker LMSW

Responsibility Summary:

1. Supervises professional and clerical employees who work with a range of functions, including but not limited to: access, pre-authorization and precertification, bed placement, coding, utilization review and denial management, care coordination collaborative treatment planning and core measures, discharge planning, clinical social work, tracking of the post-acute period and provision of disease management, and contracting internally and externally. 2. Partners with the CMO for effective relationships with physicians, services, specialties, etc. 3. Provides consultation to the executive team, forming effective relationships with all VPs and department leaders. 4. Participates in the determination and definition of the Care Management Dashboard, using data to better understand strengths and weaknesses of the hospital and department, and to determine needs, decisions, and strategies. 5. Establishes, implements, and evaluates a written strategic plan for the department that takes into account internal and external factors. 6. Establishes, manages, and constantly evaluates staffing levels, assignments, skills, learning needs, and deployment of staff. 7. Creates stable and reliable processes to anticipate and address specific situations within the department and between the department and other departments and agencies. 8. Establishes effective communication systems and forums with third party payers, the local PRO/QIO, Medical Records, and the managed care and finance offices.
9. Develops structures and processes to facilitate participation by physicians, physical therapists, social work, and other health professionals in multidisciplinary care planning, care delivery, and discharge planning. 10. Participates in continuous quality improvement groups. 11. Negotiates, approves, and manages the operational and capital budgets. 12. Writes and conducts annual and interim performance appraisals for all staff in the department.

SKILLS AND CERTIFICATIONS [note: bold skills and certification are required]
Masters in Nursing
Current New York Stat Registered Professional Nurse Licensure
Five (5) Years Hands On Care Management Leadership Experience in a Hospital Setting
 
Relocation Assistance Available - Possible for ideal candidate
Interview Travel Reimbursed - Yes
CANDIDATE DETAILS
5+ to 7 years experience
Seniority Level - Director
Management Experience Required - No
Minimum Education - Master's Degree
Willingness to Travel - Occasionally
SCREENING QUESTIONS
Have you worked in a Leadership Care Management Role in a Hospital Setting for at least 5 years?
Do you have a Masters in Nursing?

IDEAL CANDIDATE
We are looking for a Servant Leader. Someone, who can jump on and work along side staff, while simultaneously leading the team. The ideal candidate will have Five (5)  experience in a Care Management Leadership Position, within a Hospital Setting.

WHY WE'RE A GREAT COMPANY
 
A multi-institutional health system that provides a full range of acute and long term care health services to residents of the  region in Upstate New York. Acute and long term care services are provided on three campuses located in Ontario, Seneca and Yates Counties. Primary care services are provided in Ontario, Seneca, Wayne and Yates Counties.