Senior Director of Care Management & Utilization

Job Summary:
Partners with executives to develop and implement strategies, policies, programs and initiatives that support the delivery of high quality, cost effective, integrated health care. Through this partnership, the incumbent significantly impacts the cost, service and quality performance of MHS, and, ultimately the improvement of the patients health and achievement of MHSs strategic goals. Works collaboratively with Senior Leadership to establish the direction for operational activities and programs relative to the day-to- day continuing care services, including Utilization/Case Management, Social Work, Resource Stewardship, repatriation, Chaplaincy Program.
Essential Responsibilities:

• Day to Day Operations
• Directs and collaborates with Directors of Care Case Management for strategic goals of Utilization Management.
• Ensures consistency in the delivery of social work programs/services; quality management; fiscal management and;patient/community planning services.
• Collaborates with community organizations in developing new programs enhancing community services for MauiHealth System.
• Ensures consistency for Utilization Management, case care coordination, discharge planning and social services.
• Collaborates/consults with medical center physician chiefs, departmental managers, other members of the care delivery team to optimize hospital care.
• Provides leadership in the development of the quality management programs for utilization management, casecoordination, discharge planning and social services in collaboration with the Directors of Case Care Management and Manager of Social Services.
• Hires, trains, supervises, counsels, disciplines, and terminates assigned staff as appropriate.
• Communicates goals, objectives, accountabilities, priorities, and authority parameters to assigned staff.
• Utilization Compliance
• Supports Directors in ensuring that the utilization management, social services and discharge planning teams follows all regulatory and health plan policies for utilization.
• Provides leadership in the development, implementation and evaluation /improvement of effective utilization management and care management strategies ensuring compliance with external and internal regulatory bodies and standards.
• Directs regional systems and approaches for monitoring and reviewing the statistical reports for multiple operational programs to identify compliance and/or non-compliance of the program.
• Maintains a state of continuous regulatory readiness.
• Department Performance
• Provides leadership in the quality and performance criteria, policies and procedures, and service standards for the utilization management, care management, social work, and discharge planning. and social services operations.
• Provides leadership, and technical support to highly visible, large, complex multi-dimensional analytical and clinical projects. Determines goals and priorities with executive leadership. Ensure that action plans integrate well across other departments in the continuum of care.
• Strategic Planning and Implementation: Collaborates with the key leaders including physician leaders to establish priorities and strategies for MHS.
• Makes formal presentations to various senior level audiences. Assists, as needed, in planning and coordinating with other teams and projects to maximize effectiveness.
• Produces or oversees development of written materials for senior executives and other key clients.
Basic Qualifications: Experience


• Minimum ten (10) years of experience in a clinical environment to include outpatient, acute, or post-acute care,and/or home health.
• Minimum five (5) years of management experience.



Education


• Bachelors degree in health care administration, public administration, nursing, social services, health services or business OR four (4) years of directly related experience.
License, Certification, Registration
• Licensed Social Worker (Hawaii) OR Registered Nurse License (Hawaii) OR Licensed Clinical Social Worker (Hawaii)
• CPR/AED for Professional Rescuers OR Basic Life Support
Additional Requirements:


• Demonstrated knowledge of health care industry trends, developments and issues.
• Demonstrated ability to utilize oral and written communications skills and interpersonal skills such as influence, negotiation,persuasion, and conflict resolution.Ability to demonstrate and apply/utilize the principles, practices and techniques of quality management/performance improvement.
• Ability to demonstrate knowledge of Medicare, MediCal, DMHC, DHCS and other federal, state, and local regulations.Must be able to work in a union environment.
Preferred Qualifications:


• Knowledge of Utilization Management, Home Health, Palliative Care Hospice and SNF programs.
• Knowledge of local market as it relates to HI Waitlist.
• Knowledge of Social Work scope of practice.
• Masters Degree in health care administration, public administration, nursing, health services or business administration, or six (6) years of directly related experience.

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