Care Management Clinical Director

POSITION SUMMARY:

Reporting to the Executive Director/ACNO the Director of Care Management shall oversee the overall operations of Case Management Utilization Management and Social Work functions through oversight of both daily and long term activities at Boston Medical Center. In this capacity the Director is responsible for developing systems and processes for care/utilization management and social work as well as managing the departments activities related to discharge planning and clinical quality improvement.

The Director evaluates and ensures that hospital resources are used appropriately and effectively.

The Director oversees the collection analysis and reporting of financial and quality data related to utilization management quality improvement and performance improvement. The Director is accountable for achieving established performance targets through actively engaging multiple disciplines and professional staff. The Director must appropriately manage people relationships and processes in order to achieve maximized results. The Director ensures that the department achieves its goals and objectives by engaging internal and external stakeholders in care management processes at Boston Medical Center. The Director promotes interdisciplinary collaboration fosters teamwork and champions service excellence.

Position: Care Management Clinical Director

Department: Case Management Social Work

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

Plans directs and supervises all aspects of the inpatient level of care program and utilization management. Facilitates growth and development of the care management program consistent with enterprise wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices networking quality management and other activities as needed. Responsible for approving and managing the day-to-day operational budget. Oversees expense and revenue management resource (supplies and staff) utilization and relationship management with payers and network providers. Responsible for departmental personnel functions (e.g. hiring firing etc.) in conjunction with the Executive Director/ACNO. Ensures maintenance of staff qualifications competencies staffing levels workloads and productivity individual personal development of staff regulatory compliance continuing education performance appraisal system. Acts as liaison to facilitate communication and collaboration between all care partners (e.g. physicians hospitalists community social workers nurses community resources etc.). Responsible for leading a high-performance team of system thinkers who incorporate leadership principles and vision in performing the functions of care management. Responsible for the Care Management department of Social Work. Responsible for the development and oversight over social service programs to provide resources and support patients and families. Uses data to drive decisions plan and implement performance improvement strategies for care management. Utilizes patient focused continuous improvement techniques to reach key performance targets; seizes opportunities to resolve/improve processes. Ensures interdepartmental collaboration customer service regulatory compliance and monitoring of key systems. Reviews and acts upon key performance management indicators related to the strategic imperatives of the entire system. Responsible for overseeing the education of physicians managers staff patients and families related to the care management and Utilization Management process. Participants in this evolutionary process by constantly identifying future needs of current customers and/or identifying potential new customers. Ensures that the department achieves the vision goals and objectives of Boston Medical Center by developing the scope of service establishing effective relationships with physicians collaborating with other disciplines strengthening interdisciplinary processes managing flexible staffing/workload and overseeing care coordination and outcomes management duties. Conducts research as necessary to ensure that departmental practices are current and continue to meet the needs of the organization. Coordinates all campus-wide Care Management functional reporting related to utilization management social work services case management discharge planning resource coordination and quality improvement. Builds establishes fosters develops and nurtures relationships with multiple internal and external stakeholders to garner satisfactory customer results. Support the needs of physicians to provide care for patients in the most clinically appropriate setting by developing and implementing care management and outcomes management practices. Work with physicians as partners to achieve desired results for the success of all parties. Lead direct and/or educate physicians and office staff in the clinical care management program. Work with Executive Director/ACNO to develop analyze and implement Care Management and Social Work related strategies which insure the appropriateness of services level and quality of care per established clinical criteria. Identifies and resolves departmental equipment needs equipment volume supplies/accessories regulatory compliance factors OSHA safety and environment of care. Conforms to hospital standards of performance and conduct including those pertaining to patient rights so that the best possible customer service and patient care may be provided.

OTHER DUTIES:

Perform other duties as needed.

JOB REQUIREMENTS

EDUCATION:

• Masters degree required (An equivalent combination of education and experience which provides proficiency in the areas of responsibility may be substituted for the above education and experience requirements).

CERTIFICATES LICENSES REGISTRATIONS REQUIRED:

• Licensure to practice as a registered nurse in the state of Massachusetts required.

• CCM or related certification preferred.

EXPERIENCE:

• A minimum of 5 years clinical experience.

• Minimum of 10 years of progressive leadership experience in healthcare with at least 5 years in care management

KNOWLEDGE SKILLS & ABILITIES (KSA):

• Working knowledge of managed care inpatient outpatient and the home health continuum as well as utilization management and care management. Able to understand confidentiality and the legal and ethical issues pertaining to it; understand medical terminology how to obtain an accurate history; establish treatment goals; establish working relationships with referral sources; develop treatment plans.

• Ability to assess an individuals level of physical/mental impairment; understand the physical and psychological characteristics of illness; be able to assist individuals with the development of short- and long-term health goals. Understanding of how to access and evaluate the available resources to meet a clients needs; will be able to develop new resources.

• Understanding of the requirements for prior approval by payer; be able to evaluate the quality of necessary medical services; be able to acquire and analyze the cost of care; understand the various health care delivery systems and payer plan contracts; be able to demonstrate cost savings.

• Understanding of case management philosophy and principles; apply problem-solving techniques to the care management process; document cares management services; understand liability issues for care management activities.

• Self-motivated proven communication skills assertive.

• Skills necessary to build credible and effective relationships with physician leadership. Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.

• Background in business planning and targeted outcomes.

• Working knowledge of the concepts associated with performance improvement.

• Proficiency with Microsoft Office applications (i.e. MS Word Excel Access PowerPoint Outlook) and web browsers. Experience with electronic medical records.

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