Director - Care Management

Director Of Care Management

Stamford Health has an opportunity for a Director of Care Management in Stamford, CT! The Director, Care Management, is responsible for the daily oversight and management of case management, social work, utilization review, transitional care, compliant documentation, and resource utilization. He/she will provide a leadership role in developing innovative care management and alternative reimbursement models, and play a primary role in organizational efficiency and throughout initiatives.

The Director will play a leading role in coordinating and managing the quality, safety and effectiveness, of patient care transitions from and related to the acute care setting. These include transitions to ambulatory, post-acute, and community settings. The Director will lead a team that directs and facilitates relationships among hospital, ambulatory, and community based providers for seamless continuity of care, including but not limited to physician offices, clinics, hospices, skilled nursing facilities, home health agencies, LTACs, and other post-acute and community entities.

The Director will report directly to the VP Quality. He/she will work closely with the leadership of Stamford Health Medical Group, Senior VP Medical Affairs, VP of Clinical Services/Chief Nurse Executive, Chief Information Officer, Department Chairs, and Medical Staff President, in efforts to promote optimal inpatient throughput and transitional care.

Responsibilities:

• Responsible for the daily oversight, results, and management of case management, clinical documentation specialists, social services, and utilization review staff.
• Responsible for compliance with regulatory, accreditation, payer and other standards in case management, social work and affiliated activities as appropriate for a complex health care organization.
• Serve as the lead organizational resource in discharge planning and transitional care.
• Foster, lead, and direct relationships between community and hospital based providers for seamless continuity of care of patients, including but not limited to physician offices, clinics, hospice, SNFs, HHAs, LTACs, and other post-acute care community agencies and facilities
• Recognize the Planetree philosophy at Stamford Health. The Director will develop programs and have processes in place to anticipate the needs of patients and families, standardizing the approach to communication and processes to improve outcomes and satisfaction.
• Develop focused initiatives to accomplish the specific objectives of the Care Management Department as well as the overall goals of the Stamford Health System.
• Collaborate with palliative care, hospice, hospitalists and other providers in the care continuum to maximize effectiveness of the team.
• Support clinical (nursing and physician) activities by working with the care management staff and intervening with medical staff members as necessary.
• Ensure that Stamford Hospital receives all payments that it is entitled to for patient treatment through active advocacy and appeal.
• Diligently appeal concurrent and retrospective denials both verbally and in writing through the resources in the department.
• Collaborate with Clinical Chairs, Division Directors, Medical Directors and administrative leaders to continue building systems and processes to improve medical management, including participation in the development of pathways, protocols, and referral management processes.
• Provide ongoing education to leadership, medical staff, and residents, on care management.
• Serve as chair or member of key committees as requested by the SVP Medical Affairs or VP Quality.
• Provide leadership for application of evidence based practices for management, aggregation, and analysis of care coordination, quality and safety data involving publicly reported data, data registries, and institutionally-specific variables as agreed with the VP Quality.
• Responsible for leading, coordinating and managing the quality, safety and effectiveness of patient care transitions from and pertinent to the inpatient setting. This encompasses transitions both within the hospital and health system as well as in between the system and community at large. This includes admission and discharge planning and enabling disease and resource management efforts
• Key strategies may include development and enabling of:
• Value-based referral processes
• Analysis of readmission data and care protocols;
• Readmission tools and high-risk algorithms;
• Vulnerable patient home visit processes
• Strategy for outpatient care coordinator presence with affiliated PCPs;
• A process for failed transfers and readmissions;
• Processes for high risk and/or high utilizing patients;
• A scorecard for care management across the health system
• Collaborate with senior leaders, clinicians from all disciplines, directors, managers, and staff to develop, implement, and evaluate quality, safety, and efficiency in patient-centered cared delivery.
• Serve as a primary organizational liaison with public and private payers, in relation to care and utilization management processes.
• Integrate discharge planning with functional discharge summaries to ensure comprehensive care coordination.
• Embed care coordination into specialty clinics
• Evaluate institutional care coordination, quality, and safety data through use of internal data and external benchmarks as appropriate.
• Develop programs for individual care planning and communication with community providers and agencies including identifying care needs, treatment goals and objectives, objective criteria for terminating specified interventions and mechanisms to document progress in meeting patient objectives across the care continuum.
• Integrate care planning into system EHR platform, health information exchange or other appropriate systems, in conjunction with the IS team.
• Manage resources with dual emphasis on both cost containment and continuous improvement.
• Promote use of evidence-based standards and nationally recognized best practices in interdisciplinary patient-centered care delivery.
• Lead and participate in efforts to redesign care management, and develop alternative care delivery and reimbursement models.
• Provide leadership in bundled payment, accountable care, and shared risk arrangements.
• Participate in and procure externally funded care management efforts.
• Develop and manage Department and Program budgets.
• Develop and manage scorecards and performance reports in care management.
• Recruit, lead, develop, maintain, evaluate, and discipline care management personnel as necessary.
• Evaluate and recommend changes to IS systems pertinent to care management.

Qualifications/Requirements:

• Current or pending Connecticut Registered Nurse, Social Work, or Nurse Practitioner License
• Bachelors Degree in a related field is required
• Masters Degree required (in Healthcare Administration preferred)
• Certified Case Manager (CCM) or certification in care management related discipline
• Excellent organizational, communication, interpersonal and public speaking skills are required
• High level of competency with MS Office and health information technology
• Experience with personnel management in including recruitment, job description development and disciplinary processes, is required
• Experience with developing, administering, and monitoring budgets is required.
• A minimum of five years recent experience in complex case management, long term stays, including nurse assisted case management, utilization management, and disease management
• Experience with performance improvement including CMS and TJC core measures
• Prior experience working with multidisciplinary group practice and/or community based programs and facilities
• Experience in translating objective and measurable data into effective written and verbal communication
• The ability to develop and communicate policies and procedures is required
• Prior training experience such as performing in-service training is preferred
• The ability to evaluate and perform data analyses using Microsoft Excel or equivalent is required
• Prior Hospital / Health Care required and experience collaborating with physicians and nurses is preferred
• Experience in a Health Care System is preferred
• Independent, innovative, decision Maker
• Creative approach to resource management, financial, and human capital
• RAC Certification or RAC Certification eligible is preferred