Director of Care Management

Job Type: RegularTime Type: Full timeWork Shift: Day (United States of America)FLSA Status: ExemptWhen you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.Responsible for the overall operation of care transitions discharge planning and/or utilization management departments through oversight of daily and long-term activities at BILH. Accountable for achieving established performance targets through actively engaging multiple disciplines and professional staff. Must appropriately manage people, relationships, and processes to achieve maximized results. Establish working relationship with medical staff and utilize the physician advisors when necessary. Ensures that the department achieves goals and objectives by engaging internal and external stakeholders in clinical care coordination and outcomes management processes. Participates, leads and coordinates multidisciplinary teams/committees supporting clinical process improvement and delivery of quality services, while utilizing the most cost-effective measures. Responsible for ensuring system-wide regulatory compliance for continuum of care. Supports Magnet Model to engage staff if applicable.Job Description:PLANNING: Plans department's clinical services and operations including review of tracking and trending data to assess need for performance improvement targeting the requirements of all stakeholders.

Develops distinctive strategies to achieve and sustain competitive advantage for top performers.

Aligns the organization and allocates resources according to strategic priorities.

Translates broad strategies into clear objectives and practical action plans to provide guidelines to meet goals.

Promotes collaboration and removes obstacles to teamwork across the organization.

QUALITY: Utilizes patient focused, continuous improvement techniques to reach key performance targets.

Provides report card of key metrics to administration.

Seizes opportunities to resolve/improve processes.

Ensures interdepartmental collaboration, customer services, and positive working environment with physician advisors.

Ensures regulatory compliance and monitoring of key systems, including review and actions towards key performance management indicators related to strategic imperatives of entire system.

FINANCIAL: Develops and meets department budgets.

Oversees expense and revenue management including resource utilization for supplies and staff.

Oversees relationship management with payers and network providers.

Establishes and maintains communication with financial services.

Provides oversight to reduce denials through proactive utilization and case management.

OPERATIONS: Directs the development of policies, procedures, and staffing patterns essential to the day-to-day operation of multiple departments.

Conducts annual reviews, revisions to meet current trends and organizational needs.

Oversees and supports managers in hiring, transferring, suspending, promoting, terminating, assigning and rewarding employees.

Participates as needed in discipline and grievances.

COMMUNICATION: Maintains multi-directional communication network across the system with administration, faculty, house staff, clinical chairs, managers and employees.

Support the needs of the physicians to provide care for his/her patients in the most clinically appropriate setting by developing and implementing clinical care coordination and outcomes management practices.

Builds, establishes, fosters, develops, and nurtures relationships with multiple internal and external stakeholders to garner satisfactory customer results.

Establishes systems, processes, people, and education that will improve customer satisfaction and BILH results.

REGULATORY COMPLIANCE: Oversees and maintains accountability for compliance with all regulatory standards including Centers for Medicare and Medicaid (CMS), The Joint Commission, the Massachusetts Department of Public Health and Massachusetts licensing requirements as well as organizational quality improvement programs.PROFESSSIONAL DEVELOPMENT: Maintains continuing education to remain current in trends and major advances.

Participates in local, regional, and national programs to stay current in trends, major advances, and business strategies related to healthcare.

Mentors and encourages membership in local, regional, and national associations

Encourage submission and participation in professional journal articles.

Encourage participation in presenting at professional organizations

Supervisory Responsibility:   

Functional:  

Budget Development

Budget Management

Corrective Action, Counseling

Performance Reviews

Purchasing

Salary Administration

Staffing, Hiring, Terminating

Minimum Qualifications:Education:

Required:    Bachelor’s degree, RN licensure in the state of Massachusetts

Preferred:   Master’s degree, certification in InterQual®, ACM, CCM or CMAC

Specify Degree(s):   Master’s in nursing or comparable clinical degree, Business, or Health Care Administration

Experience:   

Required:   6-10 years of previous job-related experience

Preferred:   Previous experience in leadership

Managerial Experience:   3+ yearsRequired Skills:   

Ability to analyze and interpret data

Ability to communicate verbally

Ability to compile complex reports and develop presentations

Ability to compose letters and memorandums

Ability to deal calmly and courteously with people

Ability to deal with stressful situations

Ability to function independently and manage own time and work tasks

Ability to lead work teams

Ability to maintain confidentiality

Ability to negotiate, persuade and establish direction

Ability to organize workflow

Ability to plan, coordinate and develop multiple projects

Ability to work as an effective team member

Other :   Ability to function effectively in a matrix environment.

Physical Requirements & Environment:Working Conditions:  

Normal light, heat, air and space in work environment

Work takes place on hospital unit or clinical setting

Occasional exposure to unpleasant physical conditions and/or health & safety hazards

Occasional travel between sites is required

Physical Demands:   

Occasionally:

Climb-Stairs

Reaching with Arms

Finger/Hand Dexterity

Pushing/Pulling

Lifting/Carrying (Up to 25 lbs)

Frequently:

Standing

Walking

Sitting

Talking

Hearing

Seeing

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more (https://www.bilh.org/newsroom/bilh-to-require-covid-19-influenza-vaccines-for-all-clinicians-staff-by-oct-31) about this requirement.More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.Equal Opportunity Employer/Veterans/Disabled