Director - Care Management - DeKalb Medical - Atlanta

Job description
The Director of Care Management will report to Dr. Susan Breslin, RN, Chief Nursing Officer. He/She will be responsible for providing leadership and direction for the care management program for the system and managing the day-to-day departmental operational budget. Components of this program will include utilization management, case management, discharge planning, clinical resource management and capacity management. This executive will have four direct reports and roughly 50 FTEs.

Additional job responsibilities include but are not limited to:
Further develop and implement the care management plan in collaboration with the Chief Nursing Officer as well as other senior administrative, medical and clinical staff.
Further develop and implement a care coordination model that provides case management services and support at the point of service, with the intent of improving efficiency and effectiveness of the delivery of care (i.e. LOS and cost reduction programs, denial management, ER resource use program and observation status program).
Evaluate and ensure that hospital resources are used appropriately and effectively.
Oversee the collection, analysis and reporting of financial and quality data related to utilization management and performance improvement to drive decisions, plan and implement performance improvement strategies for care management.
Assure compliance with all regulatory standards regarding required utilization and resource stewardship activities. Collaborate with medical, administrative and clinical staffs to develop systems that improve processes and patient outcomes.
Develop and implement Admission/Level of Care Unit-Based Protocols for admission appropriateness.
Identify and achieve optimal targeted financial outcomes via the inpatient case management process.
Act as a liaison to facilitate communication and collaboration between all care partners.
Recruit, develop and retain high caliber staff members.
Manage staff within the care management functions to include Clinical Team Leaders, Case Managers, Utilization Management Coordinators, Social Workers, Throughput Coordinators and Case Management support personnel. Conduct and complete annual performance evaluations for the department.
Oversee the education of physicians, managers, staff, patients and families related to the care management process at the local and system level. Participate in this evolutionary process by constantly identifying future needs of current customers and identifying new customers.
Develop and implement Admission/Level of Care Unit-Based Protocols for admission appropriateness.
Identify and achieve optimal targeted financial outcomes via the inpatient case management process.
Desired Skills and Experience
The Director of Care Management must possess at least three years of experience in care management in a similar sized hospital/system or larger, with strong preference toward candidates with previous leadership experience at the director level. A Bachelor of Science in Nursing and a master’s degree in health administration, nursing or a related field is required. He/She must be licensed as a registered nurse. CCM/ACM certifications and for-profit experience are a plus. The ideal candidate will have significant experience in the full spectrum of care management from observation/admission to post admission best practices. Participation in continuing professional education within the care management field and current knowledge of CMS/Medicare guidelines is required.

Personal characteristics sought in candidates include:
Results oriented; driver of outcomes;
Data driven;
Assertive yet politically astute;
High energy, enthusiastic;
Persuasive and influential; maintains strength of convictions;
Strong communication skills;
Personable, engaging, transparent;
Visible and accessible to patients, families, physicians and staff;
A mentor; able to educate staff and physicians on best practices;
Collaborative; a team player; and
Strong physician relations.

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