Director, Care Management & Social Work

Position Details Department: CORP | Rev Cycle Admin Location: Phoenix Shift: Mon-Fri, Days, 8am-5pm Category: Director/Management Posting #: 1048096 Employee Type: Full-Time Position Summary This position is responsible for the overall leadership, strategic direction and operations oversight of Phoenix Children’s Care Coordination Departments across the enterprise, including Inpatient Care Management, Utilization Management and Social Work. This position is accountable for ensuring coordination of patient information with nursing floor management and ensuring close daily communication, as well as, being responsible for the development and implementation of a comprehensive Care Coordination, specific to Care Management, Utilization Management, and Social Work, designed to ensure the patient/family experience from end-to-end is positive, family-centered, accessible and accurate. This position manages existing Care Coordination vendor relationships, implements and manages a population health program, and collaborates with other key stakeholders to ensure patients are successfully transitioned to Phoenix Children’s Care Navigation programs with the goal of improving clinical outcomes through advocacy, partnership and innovation, while lowering the cost of healthcare. Responsibilities Provides leadership to assigned departments. Partners with the Vice President, Revenue Cycle, to develop strategies for any processes, policies and functions directly impacting case management and social work department. Develops and implements policies and procedures. Develops Key Performance Indicators and follows through by monitoring qualitative and quantitative performance metrics to ensure achievement of targeted financial and non-financial goals. Directs, manages and evaluates effectiveness and efficiency of all assigned operations, including, but not limited to Social Work, Case Management and Utilization Management by establishing controls and reviewing mechanisms for all associated procedures. Directs day‑to‑day operations ensuring compliance with regulatory and legal requirements, and quality standards, which meet or exceed community standards of care. Identifies and manages improvement initiatives impacting areas of accountability. Develops clear business plans and project plans as required. Effectively manages projects to ensure timely achievement of objectives. Manages and evaluates the effectiveness of Case Management and Utilization Management systems and reviews mechanisms affecting ability to accurately complete hospital schedules, insurance verifications, and authorizations. Identifies issues and focuses on timely implementation of appropriate corrective measures and procedures. Performs organizational and administrative duties necessary to ensure the smooth operations of assigned areas of accountability. Manages the budget process for assigned departments with subsequent management to the operating budget. Prepares, develops and reviews various financial operational reports to identify and monitor trends, activity and report changes. Develops appropriate action plans to modify results in accordance with required outcomes. Oversees the overall performance of systems and related automated applications. Evaluates new technology to enhance the processes. Manages relationships with outside vendors working on behalf of assigned areas. Ensures processes are compliant with EMTALA and other regulatory requirements. Demonstrates exceptional customer service, builds teamwork within assigned areas and with other departments of Phoenix Children’s. Maintains excellent relationships with patients, nursing, physician and other care professionals through a proactive customer service‑oriented approach. Resolves issues between parties, and refers major issues and provides feedback, analysis and insight to the Vice President, Revenue Cycle and CNO. Provides leadership on providing an excellent patient experience in all financial functions. Reviews related reports and trends on customer service experience to drive continuous improvement. Collaborates closely with Managed Care, Revenue Cycle, HIM, IT and PCMG. Works on joint teams to solve complex, interdepartmental issues. Develops team members to perform at their highest level. Develops and manages staff through the provision of timely feedback and use of appropriate Human Resources policies and tools to facilitate and ensure the ability of staff to achieve the highest level of professional growth and desired performance standards. Makes growth and development a priority by facilitating the accurate assessment of learning needs, styles and barriers to training of staff and coordinating training opportunities in conjunction with Training Coordinators and education staff. Performs miscellaneous job related duties as requested. Qualifications Education Bachelor's degree in Nursing (Required). Current credentials in Case Management or Social Work or equivalent experience (Required). Master’s degree in Nursing, Management, Organizational Development, or related field (Preferred). Experience Ten (10) or more years of experience in case management or social work (Required). Five (5) or more years of managerial experience in an acute care hospital (Required). Five (5) or more years leading functions/departments which support families with hospital resources, community resources, and/or resource/utilization management such as Social Work, Financial Counseling/Eligibility, and/or Case Management (Required). Pediatric experience (Preferred). Special Skills Working knowledge of ICD-9 and ICD-10 coding requirements, MCG and Interqual. Strong knowledge of patient access functions, especially financial clearance and financial counseling. Strong knowledge of revenue cycles, especially where clinical and financial processes intersect. Working knowledge of the financial aspects of third‑party payers and reimbursement. Effective decision‑making/problem‑solving skills, demonstration of creativity in problem‑solving, influential leadership skill. Moderate to expert computer skills. Excellent communication skills, both verbal and written as well as critical thinking, analytical expertise. Extensive knowledge of Milliman guidelines (Required). Allscripts Care Management (ACM) (Preferred). Additional Requirements Current State of Arizona RN License or an RN License from a compact state with multistate privileges (Required). Valid AZ Department of Public Safety (DPS) Fingerprint Clearance Card (Required). Certified Care Manager or Certified Case Manager Certification (CCM) (Preferred). Certification / License / Registry Requirements AZ RN License OR Compact to Arizona License OR Compact State - Required. Fingerprint Clearance Card - Required. Case Management Certification OR Certified Care Manager - Required. Physical Requirements & Occupational Exposure/Risk Potential Physical Requirement - Climbing - Frequently. Physical Requirement - Feeling (sensing textures and temperatures) - Frequently. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) - Frequently. Physical Requirement - Hearing - Frequently. Physical Requirement - Pushing/pulling - Frequently. Physical Requirement - Reaching - Frequently. Physical Requirement - Sitting - Frequently. Physical Requirement - Standing - Frequently. Physical Requirement - Stooping/crouching/kneeling/crawling - Frequently. Physical Requirement - Talking - Frequently. Physical Requirement - Tasting/smelling - Frequently. Physical Requirement - Walking - Frequently. Physical Requirement - Near Vision - Frequently. Physical Requirement - Far Vision - Frequently. Physical Requirement - Color Discrimination - Frequently. Physical Requirement - Use of keyboard, mouse and/or computer equipment - Frequently. Physical Requirement - Lift up to 35 pounds without assistance - Occasionally. Physical Requirement - Lift more than 35 pounds without assistance - Occasionally. Occupational Exposure/Risk Potential - Airborne communicable diseases - Applicable. Occupational Exposure/Risk Potential - Bloodborne pathogens or bodily fluid - Applicable. Occupational Exposure/Risk Potential - Fumes or airborne particles - Applicable. #J-18808-Ljbffr Phoenix Children's