Job Description

JOB SUMMARY:

The Regional Director of Care Management reports to the System Vice President of Care Management/Care Coordination and is responsible for the day to day management, as well as the strategic oversight of Care Management in their region. This role is responsible for creating a culture of inclusivity and develops a comprehensive, cohesive, and coordinated approach to the care of the patient; which includes building exceptional relationships with the stakeholders across the continuum. Demonstrates exceptional expertise in Care Management to garner trust and respect. Approaches problems from a system perspective, defining connections, linkages, and interdependencies as they strive to execute strategies and drive organizational goals. The incumbent prioritizes initiatives that have the greatest strategic impact on the organization and the patients served. This position works closely with multiple stakeholders on behalf of patients and must be visible across the region.

EDUCATIONAL REQUIREMENTS

• Master's Degree in Nursing or Healthcare Administration or
• Bachelor's Degree in Nursing

CERTIFICATION & LICENSURE REQUIREMENTS

• Registered Professional Nurse (RN) License Illinois upon hire and
• National Nursing Certification, Advanced Nursing Leadership within 3 years of hire and
• Case Manager Certification within 3 years of hire

EXPERIENCE REQUIREMENTS

• Five years of progressive Care Management experience

SKILLS AND KNOWLEDGE

• Resiliency and flexibility to deal with a changing health care environment.
• Ability to work collaboratively with internal/external customers.
• Ability to travel to sites within the system.

• In-depth knowledge of reimbursement requirements from external insurers and governmental agencies.
• Analytical and business skills.
• Knowledge and understanding of information systems and business software.

ESSENTIAL FUNCTIONS:

• Responsible for organizing, planning, and directing Care Management Social Work programs
• Clinical, administrative functions, and activities in accordance with Carle's Mission and Vision.
• Coordinates, facilitates, and directs Care Management and Social Work teams
• Assures integration of multidisciplinary team members and the medical staff.
• Collaborates with the System Director Utilization Management and Clinical Denial Management.

• Collaborates with other Regional Directors of Care Management for process improvement, data sharing, and strategic planning
• Achieves Regional and System goals.
• Develops and implements standards of operation, policies and procedures, workflow, and monitoring processes
• Ensures an effective case management model, fiscal accountability, and outcome measurement.
• Directs managers and others in performance and accountabilities in areas of Care Management and Social Work Services.

• Analyzes data and establishes priorities for all assigned areas of responsibility.
• Monitors the effectiveness of processes and goal achievement for all assigned areas of responsibility.
• Collaborates with Carle Health and aligned Physicians to facilitate appropriate transitions of care
• Effectively reduces hospital readmissions and inappropriate utilization of hospital resources.
• Provides regular updates to appropriate Regional Committees related to care management and social work initiatives.

• Collaborates with physicians and hospital staff to assure compliance with established standards of practice.
• Participates in the development, implementation, and utilization of clinical practice guidelines
• Promotes the use of evidence-based practice
• Assists with the integration of research findings into practice to promote positive patient outcomes.
• Cultivates and maintains productive working relationships with a wide agencies served by the hospital.

• Develops effective relationships with continuing care agencies (nursing homes, hospice, home care).
• Serves as hospital liaison for Carle Home Care, Hospice, and DME.
• Ensures programs are in compliance with accreditations (IDPH, CMS, Accrediting Organization).
• Exhibits clinical judgment necessary to interpret and follow medical guidelines and regulatory requirements.
• Monitors changes in accrediting and governmental standards

• Implements changes to policies and procedures as appropriate.
• Participates in operating and planning committees to ensure compliance with accrediting and regulatory bodies.
• Responsible for planning, developing and implementing the assigned departments' operational and capital budgets.
• Ensure quality patient care
• Services are delivered throughout the continuum of care, including program development, enhancement, and resource allocation.

• Responsible for reducing length of stay variances, readmissions, and inappropriate emergency room utilization
• Actions to accomplish cost-effective delivery of care.
• The setting of goals, objectives, and priorities in areas of responsibility.
• Determination of daily staffing levels and resource utilization in areas of responsibility.
• Fosters a patient and family consumer-driven environment.

• Identifies ways to improve services.
• Establishes key partnerships to deliver patient-centered consumer-centric solutions.
• Produces results that have a clear, positive, and direct impact on performance and organizational goals.
• Cultivation of the relationships between physician leaders and administrative staff to accomplish the goals of the organization.
• Ensures the coordination of services for a smooth continuum of care process throughout the organization.

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