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Work Shift
Job Summary:
The Director of Care Coordination will be based at Wellstar Columbia County Medical Center in Grovetown, Georgia and will report to the Chief Medical Officer. This leader will also work closely with other members of the senior leadership team to build strategies that are aligned with current performance and hospital goals and vision for the care management program, timely patient throughput, appropriate care and utilization, safe disposition planning as well as utilizing data and analytics to drive departmental performance. The director will be responsible for adherence to the system Utilization Management Plan and care coordination policies and procedures, Care Coordination standards of care, CMS and other Payer regulations, Joint Commission regulations, and will ensure that the system strategic vision is fully integrated into the culture of the care coordination program. Will align closely with physician and share performance data with individual physicians and service lines.
The Director of Case Management is responsible for the day-to-day operations for all case management activities across the hospital, including utilization management, safe transitions planning, financial performance related to payer authorization processes, avoidable day tracking and reporting, medical necessity, ongoing quality, productivity and overall efficiency for case management processes. This director will ensure that the system standardize care coordination processes are implemented and followed always. As part of the role, the director will collaborate with physicians and other departmental leaders and staff to ensure that barriers to CM outcomes such as length of stay (LOS), avoidable days, readmissions, payer denials and other CM related outcomes are address timely with attention given to identifying root causes and driving performance improvement initiatives that ensures performance is aligned to targeted goals. Must be able to manage, interpret and share data.
Other duties of the director include creating and enhancing current tools, methodologies, recruiting practices, and personnel development processes. Plays a key role in the retention, professional development and performance review of staff, including mentoring, coaching, performance appraisals and recruiting as well as departmental budgets. The director participates in committees with the hospital medical staff and other leaders to address and solve issues that drive variation from goals. Is also responsible for collaborating with other key departments that drive throughput delays and work to jointly eliminate those barriers.
Core Responsibilities and Essential Functions:
Care Coordination Leadership
* Along with senior leadership, collaborate on departmental and system wide objectives and goals.
* Co-chairs the Utilization Management Committee with the VPMO and serves as representative on internal and external committees impacting care coordination and other key hospital/system committees
* Participates in and attends WellStar Care Coordination Leadership meetings on a minimum of monthly basis.
* Recommends final approval for policies and procedures as well as operational structure for the department.
* Develop, revise and maintain education materials.
* Responsible for patient throughput and medically necessity for all patient admissions and outpatient observation and outpatient cases that occupy a hospital bed
* Accountability for sate transitions planning, timely discharges and appropriate placements for post-acute care services.
* Responsible for all hospital social services functions.
* Partners with the system to develop education modules to facilitate advanced competencies of care coordinators
* Mentors and coach staff
* Ensures focus on care coordination activities such as authorizations from payer, pre-certifications and denials management functions to assure seamless integration of care and payer reimbursement.
* Identify PI opportunities to achieve compliance with best practice by all caregivers.
* Track, trend and analyze data.
* Define opportunities for improvement from data analysis.
* Results Oriented Leadership
* Sets challenging and productive goals for team.
* Holds team accountable for actions while providing leadership and motivation.
* Provides resources and support,
* Uses checkpoints and data to track progress, setting up system and processes to measure results
Liaison for Regulatory Compliance
* Interfaces with governing bodies for necessary accreditation and utilization reimbursement for the facility and system.
* Accountable for departmental compliance and regulatory standards as well as contractual guidelines.
* Develops/implements professional standards for the program based upon recognized standards of care, The Joint Commission (TJC) and CMS standards, state/federal regulations and overall system policies and procedures.
* Monitors staff compliance of payer requirement and regulatory standards, including CMS Conditions of Participation,
* Represents team at local, State, and national meetings through educational offerings and through involvement in professional organizations
Fiscal Accountability
* Creates departmental budget and performance standards.
* Assists with the development and implementation of operational and capital budgets that are consistent with system-wide, facility/divisional goals and objectives.
* Establishes productivity measures and facilitates program and team achievement of established goals.
* Maintains FTE, salary and expense budgets at or below budgeted levels, demonstrating the ability to review/analyze current/historical data relevant to budget variances.
* Develops and maintains collaborative approaches that promote quality, cost-effective utilization services across the continuum.
Customer/Employee Satisfaction
* Promotes a positive environment to patients, families, staff and the community.
* Responds to inquiries and complaints timely and effectively and promotes a positive, professional image serving as a liaison between staff, physicians, and administration.
* Demonstrates commitment to teamwork through positive interactions and feedback to/from subordinates, physicians, peers and other customers.
* Responsible for employee morale and team performance toward goal achievement. Develops measurable, team goals, monitors progress and keeps staff abreast of progress toward achievement.
* Utilizes department metrics and develops plans to direct clinical practice performance initiatives, patient and staff satisfaction initiatives and improvements in physician relations and overall customer service.
* Represents WellStar by exhibiting values and credo
Performs other duties as assigned.
Complies with all Wellstar Health System policies, standards of work, and code of conduct.
Required Minimum Education:
- Bachelors in Nursing or Masters in Social Work is required
Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.
- BLS-I - Basic Life Support - Instructor or BLS - Basic Life Support or ARC-BLS - Amer Red Cross Basic Life Support
- RN-COMPACT - RN - Multi-state Compact or RN - Reg Nurse (Single State)
Required Minimum Experience:
- Minimum 3 years management experience of a multidisciplinary team in the field of case management or quality and patient safety is required.
- Minimum 6 years of experience in a hospital environment is required.
- Strong supervisory experience showing proven track record is required.
- Clinical Practice/Experience is required in licensed field.
- Experience in case management and/or social work is required.
- Strong employee engagement skills demonstrated by results is required.
Required Minimum Skills:
- Excellent organizational, verbal, and written communication skills
- Independent and self-directed
- Strong ability to manage data - interpret and analyze
- Ability to handle and manage change, perform critical analysis, and mentor and develop direct reports
- Knowledge of management practices and procedures, budgetary process and development and administrative and operational process
Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.
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