Position Purpose This position is responsible for In-Patient Acute Care Coordination Operations for Renown Regional Medical Center and South Meadows Medical Center. The Director will work closely with the interdisciplinary, physician and administrative team to align Care Coordination activities with the goal of establishing and achieving performance goals and metrics. This role is accountable for the strategy, development, organization and execution of all departmental activities related to Case Management, Social Worker, CDI and UR review functions. The Director works closely with Administrators, Physician Leaders, Nursing Executives, Ancillary Services, Behavioral Health, CD, Revenue Cycle, Risk Management and Community Resources to reduce operational silos, duplicative workflows and internal barriers to facilitate the timely delivery of appropriate clinical care.
Nature and Scope This position facilitates the following Case Management objectives : (1) Coordination of ancillary and specialty service referrals, from acute care, skilled nursing facility and rehabilitation facility.; (2) Collaboration with clinicians to assure appropriate clinical coordination and discharge planning, (3) facilitation of seamless patient transitions of care across the health system, and (4) ensuring compliance with state, governmental regulations, JCAHO and (5) knowledge in the benefit structure of all plans contracted with the Renown Health System. This position does not make adverse clinical determinations, but relies on the physicians to ensure proper healthcare guidelines are met in relation to inpatient services. The Director will ensure staff in this department has the tools and training they need to perform their duties at optimal levels. This department and its staff must be able to maintain a high level of knowledge of regulations and timeliness to ensure compliance with all processes. The ability to work in a fast pace environment, lead change and facilitate continues performance improvement is an expectation.
Experience and/or responsibilities include, but are not limited to the following: knowledge of ACMA, CMSA and NAWW standards of work, awareness of available health and community resources, comprehensive knowledge of health care delivery and case management within a managed care environment, comprehensive knowledge of local, state and federal laws effecting case management practice in an integrated care delivery system, working knowledge of InterQual criteria. Demonstrated ability in developing and implementing operating plans as well as analyzing and acting upon financial, clinical and quality data.
This leader shall also maintain accountability for financial performance, human resource management, planning, business and/or clinical operations, project management, and facilitating discussions regarding the necessary IT infrastructure to support operations.
Disclaimer The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Minimum Qualifications Requirements – Required and/or Preferred Name Description Education: Must have working-level knowledge of the English language, including reading, writing and speaking English. Bachelor
s degree preferred. Experience: Five (5) years of Case Management experience, with at least two years of Acute Care Experience required. Experience working with documentation to meet quality, financial and regulatory requirements is required. License(s): RN or MSW clinical licensure required. Certification(s): Professional and/or clinical certifications preferred. ACMA or CMSA Certification is preferred. Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.