Description:
JOB PURPOSE:
The Director Care Management is responsible for leading the hospitals Care Management
department, defining and maintaining standards of practice for service delivery and organizational
performance strategies consistent with PHCs Mission, Vision and Values, as well as those of the
individual hospital.
KEY RESPONSIBILITIES:
1. Provides performance improvement, operational, human resources and financial management of
the Care Management department.
2. Ensures that Care Management services, which include case management and social work, are
delivered in accordance with evidence-based guidelines, established standards of care practice
and performance, hospital policies and procedures.
3. Pursue strategies and day-to-day operations that promote quality patient throughput in a
resource/cost effective manner via effective care coordination and discharge planning.
4. Ensures that department operations and delivery align with PHC and industry quality standards.
5. Effectively promote Care Management practices as they relate to the use of software, e.g.,
InterQual, and IT systems, leveraging for information / data collection, analysis and reporting.
6. Monitor effectiveness by analyzing Average Length of Stay, Case Mix Index, avoidable days,
denials, and other key metrics.
7. Reports on regular basis with Chief Financial Officer regarding Care Management department.
8. Implements and ensures collaborative working relationship with hospital and PHC leadership,
the Utilization Management (UM) team and centralized functions, physicians, nursing, ancillary
services and other key stakeholders.
9. Works closely with UM leadership and Revenue Cycle to ensure issues are addressed in a
timely matter, and that functions & processes align.
10. Oversees monitoring of staff utilization based on workload, skill level, acuity and economic
constraints.
11. Participates in Director and Leadership activities for hospital and PHC.
12. Actively participates in strategic planning.
13. Ensures a safe work environment for CM staff.
14. Ensures appropriate training and resources are available to all staff within budgetary constraints,
and promotes professional growth of all staff.
15. Ensure that staff are consistently informed of departmental, hospital, PHC and general CM
issues.
16. Delegates responsibilities to appropriate personnel and ensures completion in a timely and effective
manner.
17. Notifies and consults with Risk Management as appropriate and per policy.
18. Provides leadership in recruitment and retention activities; performs or participates in screening,
interviewing and selection of employees.
19. Implements Human Resources policies for performance plans, deployment, severance, outplacement,
and other policies that support appropriate utilization of workforce resources.
20. Ensure that personnel and competency files are maintained in accordance with hospital, PHC, The
Joint Commission and industry standards.
21. Performs outreach activities with community based provider practices and agencies to promote care
coordination and support the CM departmental, hospital and PHC goals, as appropriate.
Qualifications:
MINIMUM EDUCATION REQUIRED:
Graduate from an accredited school of nursing or Bachelors degree in Social Work, Healthcare
Administration or other related field.
MINIMUM EXPERIENCE REQUIRED:
Seven (7) years of case management or social work experience in an acute care setting, to
include three (3) years of management experience in the acute setting.
Comprehensive knowledge of the healthcare industry, care coordination, familiarity with
government regulations, healthcare plans and utilization management.
Experience using InterQual or Milliman.
MINIMUM LICENSURE / CERTIFICATION REQUIRED BY LAW:
Licensure appropriate to the discipline.
ADDITIONAL QUALIFICATIONS:
Unrestricted registered nurse (RN) license, or eligible for RN licensure, in the state of Georgia or current
unrestricted licensed Master Social Worker (LMSW), or licensed Clinical Social Worker (LCSW) or eligible
for licensure, in the state of Georgia required.
Certification in Case or Care Management preferred.
Additional certification or Masters degree in healthcare administration and / or finance preferred.