Director Care Management Social Work

Position Summary

This position is responsible for the overall leadership, strategic direction, and operations oversight of Phoenix Childrens Care Coordination Departments across the enterprise, including Inpatient Care Management, Utilization Management, and Social Work. This position is accountable for ensuring the coordination of patient information with nursing floor management and ensuring close daily communication, as well as being responsible for the development and implementation of a comprehensive Care Coordination specific to Care Management, Utilization Management, and Social Work, designed to ensure the patient/family experience from end-to-end is positive, family-centered, accessible and accurate. This position manages existing Care Coordination vendor relationships, implements and manages a population health program, and collaborates with other key stakeholders to ensure patients successfully transition to Phoenix Childrens Care Navigation programs to improve clinical outcomes through advocacy, partnership, and partnership innovation while lowering the cost of healthcare.

• Family-Centered care focuses on the need of the child first and values the family as an essential member of the care team.
  
• Excellence in clinical care, service, and communication
  
• Collaborative within our institution and with others who share our mission and goals
  
• Leadership that set the standard for pediatric health care today and innovations of the future
  
• Accountability to our patients, community, and each other for providing the best and most cost-effectively.
  

Provides leadership to assigned departments

• Partners with the Vice President, Revenue Cycle, to develop strategies for any processes, policies, and functions directly impacting case management and social work department. Develops and implements policies and procedures. Develops Key Performance Indicators and follow through by monitoring qualitative and quantitative performance metrics to ensure the achievement of targeted financial and non-financial goals.
  
• Directs manages and evaluates effectiveness and efficiency of all assigned operations, including, but not limited to, Social Work, Case Management, and Utilization Management by establishing controls and reviewing mechanisms for all associated procedures.
  
• Directs day-to-day operations ensuring compliance with regulatory and legal requirements and quality standards, which meets or exceeds community standards of care.
  

Identifies and manages improvement initiatives impacting areas of accountability

• Develops clear business plans and project plans as required. Effectively manages projects to ensure timely achievement of objectives.
  
• Manages and evaluates the effectiveness of Case Management and Utilization Management systems and reviews mechanisms affecting the ability to complete hospital schedules, insurance verifications, and authorizations accurately. Identifies issues and focuses on the timely implementation of appropriate corrective measures and procedures.
  

Performs organizational and administrative duties necessary to ensure the smooth operations of assigned areas of accountability

• Manages the budget process for assigned departments with subsequent operating budget management.
  
• Prepares, develops, and reviews various financial and operational reports to identify and monitor trends and activity and report changes. Develops appropriate action plans to modify results in accordance with required outcomes.
  
• Oversees the overall performance of systems and related automated applications. Evaluates new technology to enhance the processes.
  
• Manages relationships with outside vendors working on behalf of assigned areas.
  
• Ensures processes are compliant with EMTALA and other regulatory requirements.
  

Demonstrates exceptional customer service and builds teamwork within assigned areas and with other departments of Phoenix Childrens

• Maintains excellent relationships with patients, nursing, physician, and other care professionals through a proactive customer service-oriented approach. Resolves issues between parties, refer to significant issues, and provides feedback, analysis, and insight to the Vice President, Revenue Cycle, and CNO.
  
• Provides leadership in providing an excellent patient experience in all financial functions. Review related reports and trends on customer service experience to drive continuous improvement.
  
• Collaborates closely with Managed Care, Revenue Cycle, HIM, IT, and PCMG. Works on joint teams to solve complex, interdepartmental issues.
  

Develops team members to perform at their highest level

• Develops and manages staff through timely feedback and use of appropriate Human Resources policies and tools to facilitate and ensure the ability of staff to achieve the highest level of professional growth and desired performance standards.
  
• Makes growth and development a priority by facilitating the accurate assessment of learning needs, styles, and barriers to the training of staff and coordinating training opportunities in conjunction with Training Coordinators and education staff.
  

Requirements

Position Qualifications

Bachelors degree in Nursing.(Required)

Current credentials in Case Management or Social Work or equivalent experience required.(Required)

Masters degree in Nursing, Management, Organizational Development, or related field.(Preferred)

Experience

Ten (10) years of experience in case management or social work.(Required)

Five (5) years of managerial experience in an acute care hospital.(Required)

Five (5) or more years leading functions/departments which support families with hospital resources, community resources, and resource/utilization management such as Social Work, Financial Counseling/Eligibility, and Case Management.(Required)

Pediatric experience.(Preferred)

Special Skills

• Working knowledge of ICD-9 and ICD-10 coding requirements, MCG, and Interqual.
  
• Strong knowledge of patient access functions, especially financial clearance and financial counseling.
  
• Strong knowledge of revenue cycles, especially where clinical and financial processes intersect.
  
• Working knowledge of the financial aspects of third-party payers and reimbursement.
  
• Practical decision-making /problem-solving skills, demonstration of creativity in problem-solving, effective leadership skill.
  
• Moderate to expert computer skills.
  
• Excellent verbal and written communication skills, as well as critical thinking and analytical expertise.
  
• Extensive knowledge of Milliman guidelines. Allscripts Care Management (ACM) (Preferred)
  

Benefits