SUMMARY OF JOB:

The Director of Care Management is a professional who is responsible for the day to day operations and administrative functions of the Care Management Department in accordance with strategic goals and mission of Redeemer Health, including system wide Care Management initiatives and safe transitions of care across the system. Provides leadership and guidance for discharge planning and safe transitions of care for all patients. Schedules staff and provides staff training and development. Facilities workflow processes and quality improvement.  Oversees the Utilization Review process for the department including authorizations, concurrent review, the detailed preparation, submission, tracking and reporting of all denials, level of care determinations and appeals. Collaborates across the health system and with community post-acute care providers for readmissions, CMS Bundle Payment Initiative and Population Health Initiatives.

CONNECTING TO MISSION:
The Leadership Team develops Redeemer Health’s vision, objectives, strategies and tactics to achieve our mission in a way that engages both the imagination and the energies of our employees. Leaders reflect the unique strengths, values, culture, and beliefs of Redeemer Health, inspiring all employees to Care, Comfort and Heal for our patients, residents, clients and each other.

RECRUITMENT REQUIREMENTS:

Bachelors in Nursing or Degreed Social Worker is required
3 years’ experience working with physicians and other healthcare providers in a leadership role required.

3 years’ experience in case management activities in a hospital setting and/or managed care environment preferred
Minimum 3 years’ experience in a clinical setting
One hour of annual stroke education
Knowledgeable of third party reimbursement strategies and Interqual and/or Milliman guidelines.

Experience with CMS Bundle Payment Initiative and value based care preferred.

Possesses the ability to negotiate and communicate effectively and professionally with members of the healthcare team and insurers.
Proven leadership qualities including the ability to develop, direct, and supervise a staff of professionals.
Ability to operate a personal computer including setting up and running spread sheets.
Ability to perform data analysis of CM reports, denial reports, readmission reports and other reports, identify areas for improvement and develop action plans to improve outcome.
Knowledgeable of DNV and CMS requirements preferred

LICENSE AND REGULATORY REQUIREMENTS:

Licensed RN with BSN or degreed Social Worker

EOE