Director Inpatient Care Management Ops

Accountable for operations and integration of all care coordination strategies for our North Illinois Advocate Hospitals including Inpatient and Emergency Department Care Management (CM) programs for an assigned area. In collaboration with the Exec Dir, ensures work processes are efficient, innovative and support a single system of care coordination. Care coordination is the development of integrating services to hardwire safe seamless transitions for patients across the continuum, improving clinical quality, create efficiencies, reducing total cost of care and improving patient and family experience. This role will interact with all key areas that impact care coordination (nursing, post-acute network, home health, physicians, and outpatient care managers, etc) This role has oversight and accountability of the Site CM leaders within their region to ensure implementation of the common vision, goal alignment, effective communication, sharing of expertise and leveraging resources at hospitals to achieve economies of scale. This role will have input into or be responsible for the Site CM leaders with regards to hiring, coaching, performance reviews, talent management, budgeting, goal and KRA establishment. These programs and strategies are essential to the quality and financial effectiveness of our risk contracts.

Major Responsibilities:

• Strategy & Integration - Accountable for contributing to development of the enterprise strategic and annual operating plans for IL or WI for Advocate Aurora care coordination inpatient and ED care management programs in alignment with enterprise population health. Integrates national best practices and benchmarks into the program to ensure optimal outcomes for the healthcare system. Ensures the care management inpatient program goals are aligned with the overall Advocate strategic initiatives in enterprise population health. Responsible for developing a professional, team-oriented, service culture that contributes to the goals of the enterprise and department. Has expert knowledge of the processes related to financials in the revenue cycle model; supports and directs initiatives that result in improved quality, efficiency and financial performance.
• Performance Management - Provides accountability and oversight for the development of structures, processes and initiatives designed to improve care coordination projects that will define the continuum of care for each patient population and best practice solutions for care coordination. Ensures a plan for education, communication, training and implementation planning. Serves as a leader for oversight for the AAH site CM leaders to ensure delivery of the vision, strategies, and roadmap including utilization outcomes, process metrics, and financial performance of all value based contracts (significant impact on the AAH financial performance). Provides leadership/mentorship to site leaders of CM for effective implementation and optimal performance. Leads in setting performance management goals, operating plans, dashboards, and outcome tracking tools to ensure performance is monitored, on target and achieving intended outcomes. Rounds on site CM leaders at AAH sites including observations and onsite reviews/rounds to ensure project deployment and operation are in alignment with system goals/targets. Works with performance improvement and project managers as project leads related to care coordination tactics as assigned (Medicare Bundled Payments for Care Initiatives and Medicare Shared Savings Program).
• Communication / Relationships - Accountable for communication and data reporting to Site Leadership Teams and key stakeholders. Provides leadership and mentorship to site managers and supervisors to ensure effective implementation, change management, and optimal performance. Collaborates with Executive Director in setting KRAs, operating plans, dashboards, and outcome tracking tools to ensure performance is monitored, on target and achieving intended outcomes.
• Budgeting - Accountable for site operating / capital budgets.
• Regulatory & Compliance - Ensures that the site care management programs for the assigned region operate under compliant CMS, federal and state practice standards and codes of ethics.
• Technology - Ensures appropriate care management tools and software are operational and support the needs of the strategic plan and initiatives for Integrated Care Management for AH.
• Utilization Management - Site oversight for the utilization management operations for AH as assigned that are part of the comprehensive care management program that supports reimbursement and revenue enhancement. Works collaboratively with payers, providers to ensure a standardized, efficient, and highly effective process for UM. Identifies opportunities related to appeals of medical necessity denials and quality inquires. Demonstrates expertise in utilization management and clinical reimbursement that demonstrates a working knowledge of current admission, continued stay, and discharge appropriateness criteria.
• Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
• Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
• Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business.

Licensure, Registration, and/or Certification Required:

• Registered Nurse license issued by the state in which the team member practices, or
• Social Worker license issued by the state in which the team member practices and
• RN or SW: Accredited Case Manger (ACM) or SW (ACM) certification issued by the American Case Management Association (ACM) needs to be obtained within 1 year, or
• RN or SW: Certified Case Manager (CCM) issued by the Commission for Case Manager Certification (CCMC) needs to be obtained within 1 year, or
• RN: Nursing Case Management (RN-BC) certification issued by the American Nurses Credentialing Center (ANCC) needs to be obtained within 1 year, or
• SW: Certified Social Worker in Health Care (C-SWHC) issued by National Association of Social Workers to be obtained within 1 year

Education Required:

• Master's Degree in Nursing, or
• Bachelor's Degree in Nursing, and Master's Degree in Health Care Administration or related field.
• Or Master's Degree in Social Work

Experience Required:

• Typically requires 7 years of experience in clinical experience. Typically requires 3 years of management experience in clinical environment.

Knowledge, Skills & Abilities Required:

• Strong analytical ability to gather, interpret, and utilize data in decision-making
• Demonstrated self-direction and results orientation
• Expertise in operations improvement and quality management
• Demonstrated excellence in organizational and project management skill
• Critical thinking skills
• Proficiency with word processing, spreadsheet, PowerPoint and graphic presentation software
• Demonstrated political sensitivity to the dynamic interplay that occurs between hospital sites
• Demonstrated success facilitating teams on complex projects
• Strong leadership skills
• Ability to work in an unstructured, developing environment
• Flexible hours
• Frequent travel
• Experience in an integrated health care delivery model across a continuum of services such as care management models
• Understanding of analytics and performance metrics that drive behavior
• Experience working with contracts where financial performance is at risk for a health care delivery system
• Strong operational skills including strategic planning, operational work plans with demonstrated adherence to timelines
• Ability to lead a team and work with a diverse team of stakeholders
• Excellent presentation skills with experience communicating with high level executives internally and externally with outside stakeholders.

Physical Requirements and Working Conditions:

• Must be able to sit for approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time.
• Must lift up to 10 lbs. continuously, up to 20 lbs. frequently, and up to 50 lbs. occasionally.
• Manual dexterity required for operation computer and calculator.
• Visual acuity required to facilitate review of written documents/computer screens, medical records, and to record information accurately.
• Clear oral communications and hearing acuity required for receiving instructions and converse on standard telephone.
• Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone.
• Exposed to normal office environment; including usual hazards related to operating electrical equipment.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.