Director Care Coodination

Overview

JOB SUMMARY / PURPOSE:

The Director of Care Coordination (CC) is responsible for the implementation, evaluation and direction of Care Coordination in support of the CommonSpirit Health Care Coordination model. The leader has oversight of clinical resource management, progression of care, discharge planning activities, patient advocacy and clinical social work. In collaboration with the National Market Director Care Coordination, the CC Director develops strategies to achieve
departmental and CommonSpirit Health goals and objectives.

This position directs the CC staff to meet or exceed operational performance standards. The Director oversees the implementation of CC policies, procedures and processes; directs and assists with accreditation activities; management of progression of care, addresses psycho-social needs; and, compliance with payer and regulatory requirements to achieve Care Coordination program outcomes and quality metrics.

Responsibilities

ESSENTIAL KEY JOB RESPONSIBILITIES:

1. Provides strong leadership and direction to the care coordination department, including staff supervision, team building, and performance management.
2. Develops, implements, and evaluates care coordination programs and strategies to optimize patient care, resource utilization, and quality outcomes that align with system-wide Care Coordination.
3. Ensures that the care coordination department adheres to all relevant healthcare regulations, accreditation standards, and organizational policies.
4. Oversees the daily operations of care coordination, including staff supervision, budget management, and resource allocation in alignment with organizational goals.
5. Leads improvement groups and collaborates with healthcare providers, insurance companies, and other internal and external stakeholders to coordinate patient care and facilitate communication across the care continuum.
6. Monitors and analyzes data related to care coordination activities, patient outcomes, and resource utilization to drive decision-making and improvements.
7. Trains and evaluates care coordination staff to ensure they are aware of and implementing system initiatives, possess the skills and knowledge necessary for effective performance and completion of required education.

8. Advocates for patients' needs and rights, ensuring they receive appropriate care and support throughout their healthcare journey.
9. Maintains effective communication with system, regional, market and care facility leadership, clinical staff, and external stakeholders to facilitate efficient care coordination operations.
10. Drives and engages multidisciplinary teams and committees to address complex patient care issues and develop integrated plans of care.
11. Ensures and monitors the established goals and key performance indicators (KPIs) to drive continuous improvement.
12. Collaborates with Utilization Management Hub leaders on trends and opportunities, ensuring action plans are developed to address identified gaps.
13. Directs recruitment, performance management, coaching, mentoring, training and development of care coordination staff and leaders.

Required Minimum Knowledge, Skills, Abilities and Training:

• Apply clinical guidelines to ensure progression of care
• • Communicate effectively in writing and verbally
  • Must have analytical, critical thinking and problem-solving skills
  • Collaborate effectively with multiple stakeholders
  • Proficient in the use of computers and multiple software programs
  • Actively work within electronic health record (Epic, Cerner, Meditech, and/or Paragon)
  • Understand how utilization management and care coordination programs integrate
  • Work as a team player and assist other members of the team where needed
  • Thrive in a busy, self-directed environment
  • Knowledge of CMS standards and requirements
  • Proficient in prioritizing work and delegating where indicated
  • Highly organized with excellent time management skills

Qualifications

Required Education and Experience:

• Bachelor's Degree in Nursing (e.g. BSN) or Masters in Social Work or equivalent education and experience
• Minimum of 4 years of clinical care coordination experience, (Utilization Management, Denial Management, Care Coordination) or 5 years of progressively responsible management experience

Preferred Education and Experience:

Master's degree in Nursing, Health Care Administration or related clinical field preferred.
• Experience with data analytics related to include cost containment, over/under utilization assessment and clinical outcomes

• Extensive operational experience, program planning, implementation, staff development, and needs assessment in healthcare environment
• Comprehensive knowledge of care coordination and discharge planning

Required Licensure and Certifications:

Current unrestricted RN license where practicing required or clinical SW license

WA LICSW (Licensed Independent Clinical Social Worker)

National certification in either of the following: CCM (Certified Case Manager), ACM (Accredited Case Manager) required or within 2 years upon hire