Director of Care Management

united states

Carle Health combines clinical care, health insurance, research and academics in a way that solves real-world problems today with an eye toward the future. Supported by a deep philanthropic spirit, Carle is dedicated to doing what it takes to make life better for as many as possible. Its mission is to serve people through high-quality care, medical research and education.

Based in Urbana, IL, Carle Health is an integrated system of healthcare services, which includes a five-hospital system, multi-specialty physician groups, as well as Carle Illinois College of Medicine and the Stephens Family Clinical Research Institute. Named a Great Place to Work®, Carle Foundation Hospital also ranks as one of America’s 50 Best Hospitals™ by Healthgrades® and both Carle Foundation Hospital and Carle BroMenn Medical Center hold Magnet® designation, the nation’s highest honor for nursing care.

The system includes five hospitals with 807 beds, multi-specialty physician group practices with more than 1,000 doctors and advanced practice providers, and health plans including FirstCarolinaCare and Health Alliance. Health Alliance is a leading provider-driven health plan serving Illinois, Iowa, Indiana, Ohio and Washington, and FirstCarolinaCare health plan serves North Carolina.

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Position Summary:

The Director of Care Management (East/South Regions) reports to the System Vice President of Care Management/Care Coordination and is responsible for the day-to-day management, as well as the strategic oversight, of Care Management in their region. This role is responsible for creating a culture of inclusivity and develops a comprehensive, cohesive, and coordinated approach to the care of the patient, which includes building exceptional trust and strong relationships with the stakeholders across the continuum. Demonstrates exceptional expertise in Care Management to garner trust and respect. This position works closely with multiple stakeholders on behalf of patients and must be visible across the region.

Qualifications:

EDUCATIONAL REQUIREMENTS

Master's Degree in Nursing or Healthcare Administration

CERTIFICATION & LICENSURE REQUIREMENTS

Registered Professional Nurse (RN) License Illinois upon hire and National Nursing Certification Certified Case Manager upon hire

EXPERIENCE REQUIREMENTS

Minimum of five years of progressive Care Management experience

SKILLS AND KNOWLEDGE

Resiliency and flexibility to deal with a changing health care environment. Ability to work collaboratively with internal/external customers. Ability to travel to sites within the system. In-depth knowledge of reimbursement requirements from external insurers and governmental agencies. Analytical and business skills. Knowledge and understanding of information systems and business software.

Essential Functions:

Responsible for organizing, planning, and directing Care Management Social Work programs' clinical and administrative functions and activities in accordance with Carle Health's s Mission and Vision

Coordinates, facilitates, and directs Care Management and Social Work teams, assuring integration of multidisciplinary team members and the medical staff

Collaborates with the System Director Utilization Management and Clinical Denial Management

Collaborates with other Regional Directors of Care Management for process improvement, data sharing, and strategic planning to achieve Regional and System goals

Develops and implements standards of operation, policies and procedures, workflow, and monitoring processes, to ensure an effective case management model , fiscal accountability, and outcome measurement.

Directs managers and other staff members in performance of their accountabilities in the areas of Care Management and Social Work Services

Analyzes data and establishes priorities for all assigned areas of responsibility. Monitors the effectiveness of processes and goal achievement for all assigned areas of responsibility

Collaborates with Carle Health and aligned Physicians to facilitate appropriate transitions of care to effectively reduce hospital readmissions and inappropriate utilization of hospital resources

Provides regular updates to appropriate Regional Committees related to care management and social work initiatives

Collaborates with physicians and hospital staff to assure compliance with established standards of practice. Participates in the development, implementation, and utilization of clinical practice guidelines within the medical center. Promotes the use of evidence-based practice and assists with the integration of research findings into practice to promote positive patient outcomes

Cultivates and maintains productive working relationships with a wide spectrum of community health, welfare, and social agencies served by the hospital

Develops effective relationships with continuing care agencies (nursing homes, hospice, home care). Serves as hospital liaison for Carle Home Care, Hospice, and DME.

Ensures care management and social work programs are in compliance with standards associated with accreditation (IDPH, CMS, Accrediting Organization). Exhibits clinical judgment necessary to interpret and follow medical guidelines and regulatory requirements. Monitors changes in accrediting and governmental standards and implements changes to policies and procedures as appropriate. Participates in various operating and planning committees to ensure compliance with accrediting and regulatory bodies

Responsible for planning, developing and implementing the assigned departments' operational and capital budgets

Uses solid Care Management leadership skills to ensure that quality patient care and services are delivered throughout the continuum of care, including program development, enhancement, and resource allocation

Responsible for reducing length of stay variances, readmissions, and inappropriate emergency room utilization, which all have a tremendous impact on hospital revenue

Actions to accomplish cost-effective delivery of care. The setting of goals, objectives, and priorities in areas of responsibility. Determination of daily staffing levels and resource utilization in areas of responsibility

Fosters a patient and family consumer-driven environment. Identifies ways to improve services. Establishes key partnerships to deliver patient-centered consumer-centric solutions

Produces results that have a clear, positive, and direct impact on performance and organizational goals

Cultivation of the relationships between physician leaders and administrative staff to accomplish the goals of the organization

Ensures the coordination of services for a smooth continuum of care process throughout the organization

Carle Health offers a competitive compensation and benefits package including relocation/sign-on bonus. Candidate hired must live in the Champaign-Urbana area (not a remote position).