- Master's Degree Preferred
- Licensed/Certified to practice
- Three to five years experience required
DIRECTOR OF CARE COORDINATION
The Director of Care Coordination, under the direction of the Vice President for Quality and Regulatory Services and in alignment with the Strategic and Operational Goals of St. Joseph Healthcare, is responsible for providing leadership, planning, organizing, managing and monitoring of the outcomes of the Care Coordination Team (which includes Social Service staff, Case Managers, Utilization and Denials Management, and Interpreter Services). The Director will be required to maintain collaborative ties with the Quality Improvement staff, the Medical Staff, Nursing Staff, clinical department leaders, ancillary staff as well as pre-hospital and post-hospital providers, payors and agencies with the overall goal of improving transitions in care and patient outcomes.
Requisite experience, knowledge, skills requirements:
- · Knowledge of emerging healthcare reform initiatives required.
- · Knowledge of disease management, clinical best practices, health care quality, and case management required.
- · Experience in establishing new programs related to care transitions and overall care coordination highly preferred.
- · Knowledge of accreditation and licensure requirements desirable.
- · Clinical experience across the continuum of care (physician practice, home care, acute care and post-acute care) highly desirable.
- · Experience managing human resource issues, staff conflict resolution, group dynamics, scheduling of staff and disciplinary matters essential.
- · Experience with financial budgets and tracking of expenses essential.
- · Knowledge of reimbursement principles, utilization management and denials and appeals essential.
- · Knowledge of quality tools and principles (i.e., control charts, Donabedian principles, risk adjustment models) highly desirable.
- · Knowledge and experience with interpersonal interaction and change theory essential.
- · Skilled in communicating with all levels of the organization both orally and in writing.
- · Skilled in administrative and clinical research for achieving best practices.
- · Knowledge of project management steps and the ability to successfully implement process improvement changes.
- · Skilled in establishing and ordering multiple priorities to meet overall goals and objectives.
- · Skilled in Microsoft products (Word, Excel, Access, Outlook and Powerpoint) with the ability to adapt to the use of other software products related to Care Coordination (e-discharge, Interqual, Crimson, EMR, etc.).
Major Areas of Responsibility:
- · Assist in the development and implementation of a Care Coordination Model (in collaboration with other key stakeholders) which will serve as a basis for adapting to changing reimbursement models under Accountable Care principles with the overall intention of improving quality outcomes, cost, efficiency, provider/patient shared decision making and the improvement of population care within and outside the walls of the hospital.
- · Develop positive, effective relationships with payers, pre and post hospital providers and referral sources to facilitate appropriate utilization of clinical services and innovative care coordination initiatives.
- · Work with staff and in multi-disciplinary teams (including the hospitalists and other attending physicians) to resolve issues related to difficult placements and discharge planning needs of patients.
- · Collaborate with service line administration to adjust care strategies to accomplish established goals.
- · Direct the process of assessment, planning, facilitation and advocacy of options and services that meet patients' health needs.
- · Use Process Improvement models to evaluate and improve processes that contribute to optimal patients' flow through the healthcare system within St. Joseph Healthcare and in collaborating with other providers outside of St. Joseph Healthcare.
- · Develop policies, protocols and tools in conjunction with key stakeholders.
- · Prepare and monitor budgets.
- · Provide outcomes reports on key indicators related to process measures, outcome measures, care coordination, resource utilization and compliance working collaboratively with key quality and compliance staff.
- · Build and maintain effective partnerships with external providers of care (nursing homes, home health agencies, physicians, etc.) to meet the needs of patients and families focusing on patient centered principles.
- · Develop a dashboard in conjunction with members of the Quality department for the Care Coordination Team to track processes (patient satisfaction, readmission rates, length of stay, inpatient denials, appeals, etc.).
- · Assure compliance with regulatory and payor requirements related to level of care, notice to beneficiaries for lack of medical necessity, etc.
- · Hire and discipline staff, provide performance evaluations of staff, supervise orientation and training of staff and perform other responsibilities related to employee matters, as required.
- · Perform other responsibilities as the needs arise.
Education and Credentials:
- · A Bachelors degree in a Health related field required.
- · Master's degree highly preferred (will consider a candidate who is actively pursuing graduate studies).
- · Licensure as a R.N. in New Hampshire.
- · Case Management certification or other related certification preferred.