Director Care Transitions
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Job Summary
This position provides leadership for the development and performance monitoring of care management services, manages resources and supervises care management leaders across multiple entities. The Director of Care Transition provides overall direction and oversight of the care management function to achieve outcomes in alignment with system strategy and initiatives.
Job Description
Strategy / Operations - Responsible for the effective daily operation of the care transition function. Responsible for providing and/or implementing strategies to improve operations and outcomes.
Determines proactive strategies and methods necessary for a high-performance culture related to care transition management.
Utilizes change management techniques to facilitate leader and staff adoption of workplace changes.
Directs the activities of the Care Transition Managers (RN & SW).
Serves as a content expert on the following: Compliance with program expectations Mitigation activities with all clinical partners / payors as needed. Compliance requirements: Code 44 intervention, HINN letters, IMM, Observation letter, etc. Potential denials, avoidable days, alternate level of care days, etc. Medical necessity criteria, patient status, and discharge criteria. All clinical and transition documentation Clinical Review staff requirements and communications Psychosocial issues related to hospitalization and transition planning Child and Adult Protective Care Services cases (neglect, abuse, etc.)?? as appropriate. Adoptions Complex behavioral health cases Applications for community resource needs. Guardianship processes Mental Health Treatment Declaration, Notification of Emergency Detention, and court applications for mental health services Indigent programs as appropriate
Develops and oversees the implementation of policies, procedures, and standards that provide structure for care transition management.
Participates in the development of new staffing and care coordination designs that support system goals.
Supports standards that are consistent with hospital, community and nationally recognized evidence-based practice.
Participates in collection and analysis of clinical and financial data (e.g., LOS data, avoidable days, adverse determinations, and denials/appeals) and makes recommendations to improve performance.
Achieves and maintains high levels of internal and external customer satisfaction?? specifically collaborating with leaders and others across entities and channels in the development, implementation and evaluation of programs and services.
Develops and manages the operating budget as required by THR.
Leadership - Responsible for providing overall direction and oversight to the care management function to obtain expected outcomes.
Directs the activities of the organization related to Care Transition Management.
Provides input into the strategic planning processes for THR and medical staff.
Participates in appropriate THR and community forums.
Achieves positive results for the organization related to investigations of complaints requiring the Directors direct involvement.
Facilitates as lead staff at various organizational level meetings; often represents the organization with respect to third party payors and intermediaries.
Provides educational offerings on new tools, techniques and approaches to a wide variety of audiences as appropriate.
Support and promote community health activities among staff and colleagues including thru community initiatives.
Maintains excellent professional relationship with system and entity leadership teams.
Communicates and collaborates with the system (THR) in the areas of data and information management, performance improvement, care coordination, care transition management, medication management, and social services including THR committee participation, as well as direct interactions with leadership and staff at the appropriate THR departments.
Human Resources - Develops and implements strategy to create a positive employee relations environment. Supports activities to recruit, orient and retain competent staff. Mentors job related growth of managers & staff.
Oversees the effectiveness of the department recruitment and retention program, taking action as necessary to provide an adequate level of qualified staff.
Promotes professional growth, development and accountability in staff, students and colleagues.
Tracks and evaluates staff performance and individual accountability for achieving expectations.
Coaches and mentors staff to improve their performance and continue to develop their professional skills.
Identifies leadership talent and actively develops leadership skills in staff.
Supports diversity objectives of the organization in recruiting and promoting.
Achieves and maintains high levels of employee satisfaction.
Establishes and maintains professional relationship with medical staff.
Orients medical staff on care transition management principles.
Escalates issues to Chief Quality Medical Officer (CQMO), Physician Advisor, and/or Senior Director as appropriate.
Fiscal Responsibility - Develops annual capital and operational budget and monitors compliance of same. Considers clinical, quality and operational outcomes and financial implications when making recommendations for changes in practices/operations. Evaluates use of newly developed technology or products for cost effectiveness.
Reviews budgets and justifications
Develops action plans to address variances (positive and negative) as needed.
Utilizes management reports to evaluate budget and staffing variations.
Resolve daily staffing issues as needed.
Customer Satisfaction - Incorporates customer needs and expectations into daily operations and business planning strategies. Promotes team building strategies and principles of group process in interaction with staff.
Reviews customer satisfaction evaluations on a regular basis to determine gaps between actual and expected performance.
Takes appropriate action in conjunction to remedy actual vs. expected performance gaps in a timely manner.
Reviews and discusses patient, staff, physician, and other department complaints
Education
Bachelor's Degree in Nursing or Master's Degree Social Work required
Master's Degree preferred
Experience
5 years directly related experience in hospital case management, demonstrating progressive developmental and management growth inclusive of supervisory and leadership experience required
Licenses and Certifications
RN - Registered Nurse, Or, LMSW - Licensed Master Social Worker required upon hire
CPR - Cardiopulmonary Resuscitation required upon hire
ACM - Accredited Case Manager, Or, CCM - Certified Case Manager, Or, CPUM - Certified Professional Utilization Manager, Or, ANCC preferred upon hire
Skills
Knowledge of industry standards related to Joint Commission, CMS, OSHA, regulatory standards for areas of responsibility.
Knowledge of continuous improvement tools and techniques such as Six Sigma, Lean, and Clinical Microsystems.
Knowledge of managed care contracting and standards, medical necessity, and precertification experience with transition issues.
Knowledge of home health, skilled nursing rehabilitation setting as related to coordination of care across the continuum.
Preferred experience with electronic health record and automated case management systems.
Must be able to analyze and manage information.
Excellent verbal/presentation and written skills with the ability to communicate effectively with
a wide variety of professional and nonprofessional stakeholders.
Able to supervise a diverse and independent staff.
Individual must be self-directed and goal/outcomes/measurement driven.
Must be adept at Microsoft Office suite, statistical analyses and displays of information.
Why Texas Health?
At Texas Health Resources, our mission is “to improve the health of the people in the communities we serve”.
As part of the Texas Health family and its 28,000+ employees, we’re one of the largest employers in the Dallas Fort Worth area. Our career growth and professional development opportunities are top-notch and our benefits are equally outstanding. Come be a part of our exceptional team as we improve the health of the people in our communities every day. You belong here.
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