Director of Case Management AdventHealth Palm Coast

Location Address: 60 Medical Memorial Parkway, Palm Coast, FL 32164

Top Reasons To Work At AdventHealth Palm Coast

• Immediate Health Insurance Coverage
• Great benefits such as: Educational Reimbursement
• Career growth and advancement potential
• High quality of life with low cost of living on the shores of sunny Palm Coast, FL

Work Hours/Shift:

Full Time Days

GENERAL SUMMARY:
The Care Management Facility Director has full accountability and oversight for the overall operations of the Care Management department, including but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services (CMS) Conditions of Participation, Discharge Planning, Social Services, Readmission Prevention, Length of Stay, Excess days, Avoidable Days, Value Based Care partnerships, Care Manager’s roles in Multidisciplinary Rounds, Care Transitions, team member engagement, team member evaluations and customer experience.
The Care Management Facility Director leads, manages, and supervises all activities of the Care Management Manager, Team Leads, Care Managers, Social Workers and Care Manager Assistants to ensure appropriate care coordination and care transition handoffs for all patients. The Care Management Facility Director will provide monthly metric reports and mitigation plans to the Care Management Divisional Director.
The Care Management Facility Director reports directly to the Division Care Management Director with a matrix reporting relationship dotted line to the Facility CNO. The Care Management Facility Director works closely with the Facility CNO to implement the Corporate Care Management strategies. The Care Management Facility Director meets regularly with the CMO to align Care Management work with Providers and keep the CMOs updated. The Facility Care Management Director communicates regularly with the CFO to provide a bidirectional communication to keep Facility CFOs updated on Care Management initiatives and progress.

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:
● Directs the daily operations of the Care Management department, including all aspects of care coordination, care transition and compliance guidelines
● Implements the Corporate Care Management strategies
● Responsible for providing and or implementing strategies to improve operations and outcomes
● Determines proactive strategies and methods necessary for a high-performance culture related to Care Management
● Supports change management and movement toward interaction with outpatient Care Management
● Assists in the development and oversees the implementation of Care Management policies, procedures, and standards
● Participates in the development of new staffing and care designs that support system goals while achieving best in class performance
● Supports standards that are consistent with hospital, community and nationally recognized evidence-based practice
● Collaborates with C-Suite and other hospital leaders to maintain a collaborative professional relationship to achieve goals
● Works collaboratively with leaders of Utilization Management to quickly and efficiently address any Care Management or Utilization Management concerns or barriers
● Escalates operational and/or financial concerns to Physician Advisor(s) as appropriate
● Determines proactive strategies and methods necessary for a high-performance culture related to Care Management
● Identifies process improvement opportunities and develops, implements and monitors action plans based upon identified Care Management metrics
● Educates and mentors facility Care Management staff on interpretation of data and the performance of causal analysis; Reports findings to appropriate facility and divisional leaders
● Achieves positive results for the organization related to investigations of complaints requiring the Director's direct involvement
● Available for one-on-one meetings with a wide range of stakeholders for education/development and problem solving
● Maintains excellent professional relationships with facility and divisional leadership
● Communicates and collaborates across the facility in the areas of data and information management, performance improvement, care coordination, care transition management, medication management, and social services
● Provides leadership to and actively participates with facility staff to identify, implement, or enhance Care Management programs consistent with AdventHealth and facility strategy
● Ensures the facility's Care Management staff are practicing at the highest level of excellence
● Oversees the effectiveness of the department’s recruitment and retention program, taking action as necessary to provide an adequate level of qualified staff
● Coaches/mentors staff to improve their performance and develop their professional skills
● Identifies leadership talent and actively develops leadership skills in staff
● Supports diversity objectives of the organization in recruiting and promoting
● Creates and implements change management strategies and plans that maximize employee adoption and minimize resistance
● Compiles and reviews budgets and justifications submitted by Care Management Manager
● Provides assistance to the Care Management Manager and Supervisor to develop action plans that address variances
● Utilizes management reports to evaluate budget and staffing variations
● Assists Care Management Divisional Director with operating budget for Care Management

KNOWLEDGE AND SKILLS REQUIRED:
● Understanding of medical necessity for appropriate patient status and level of care
● Understanding of Care Management best practices
● Ability to research and reason best practices to support process improvement
● Strong verbal and electronic communication skills
● Ability to analyze, evaluate and monitor data in addition to provide action plans
● Supports positive employee relations and customer experience
● Understanding of Microsoft Office Products and other appropriate software platforms
● Understanding of CMS Conditions of Participation for Discharge Planning
● Understanding of Managed Care and Value Based Programs
● Ability to work autonomously with self-direction
● Ability to work as a collaborative partner of a diverse leadership team
● Ability to lead and sustain change
● Knowledge of change management principles, methodologies, and tools

KNOWLEDGE AND SKILLS PREFERRED:
● 3-5 years of Director and/or Manager of Care Management level of experience
● Sustained goals of Care Management metrics, voice of the customer experience, employee engagement, and quality outcome viability of a Care Management program

EDUCATION AND EXPERIENCE REQUIRED:
● Registered Nurse: BSN
● Social Worker: MSW or BSW + Masters in related field
● 5 years of Care Management experience performing hospital discharge planning
● 3 years of Manager level (or above) experience in Care Management/Social Work leadership

EDUCATION AND EXPERIENCE PREFERRED:
● Registered Nurse: MSN
● Social Worker: MSW with LCSW
● 5-7 years in Care Management leadership (manager level or above) in addition to 5 years of direct Care Management/Utilization Management experience and increasing leadership responsibility

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:
● State Specific RN license if a nurse
LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:
● RN-BC Certification in Care Management