Director Case Management - Medical Affairs Leadership

Position Information

The Director of Case Management is a multi-faceted leadership position responsible for directing all aspects of case management, social work, and discharge planning for the Medical Center and across the care continuum. This position requires advanced knowledge and expertise to identify and implement a comprehensive and optimized case management program that spans across the care continuum in order to provide patients care at the right time by the right people and in the right setting. This leadership position requires extensive experience in working with advanced discharge planning and care continuum needs. The Director of Case Management is responsible for implementing and developing programs aimed at helping us meet our strategic priorities of optimizing length of stay and reducing readmissions. Other focuses include ensuring appropriate post-acute care utilization, reducing unnecessary hospital utilization, and improving chronic disease management. This leadership position is responsible for clinical, quality, and cost effective outcomes and will collect, trend, and analyze data to be used in identifying opportunities and targeting performance improvement efforts. This individual understands how healthcare’s shift to value-based payment models requires organizations to focus on improving care and engaging physicians with high risk/high need individuals. The Director of Case Management is responsible for working closely with community partners including Skilled Nursing Facilities, Home Health Care Agencies and other organizations within the community who can assist LRH achieve its strategic goals. Strategies such as employing a population health management approach, implementing team-based and integrated care models, quality improvement and addressing the social determinants of health are all methodologies with which the Director of Case Management should be familiar. The continuum of care includes pre-inpatient, inpatient, outpatient, post-acute and community settings.

Work Schedule: Weekdays with Occasional Weekends
Work Hours per Biweekly Pay Period: 80
Location: Medical Center, US:FL:Lakeland

Position Highlights

• Award Winning Workplace: Best workplace awards from Forbes, Becker's & Gallup; "Most Wired Advance" Hospital
• Technology: State-of-the-art cancer center, robotic surgery, hybrid operating rooms, and advanced rehabilitation 
• Growth and Opportunity: Brand new buildings and services added to care for women, children, cancer patients, and stroke/TBI patients
• Employee-centric: Guided by the Quality-Caring Practice model, relationship-centered care is at the heart of all we do.
• Care for You: Comprehensive health benefits on eligible positions, robust retirement plan, and exceptional tuition reimbursement
• Stability: 100-years in business!

Position Details

Detailed responsibilities:

• Standard Work Duties: Director - Case Management
  • Develop, execute, and evaluates a case management program which: ensures appropriate levels of care; ensure appropriate settings for care; improves access to care; increases patient and family knowledge and involvement of care required; delivers cost effective care with desired outcomes; integrates services and resources into the community; ensures smooth transition across the care continuum.
  • Develop and implement system strategies to optimize a coordinated care model that results in improved coordinated care, optimized length of stay, decreased re-admissions, and improved management of chronic disease.
  • Develop standard work for case management, social work, and discharge planning functions and develop plans and processes to continually audit and sustain standardization efforts. Ensure work is consistent with regulatory standards.
  • Provides information for state and federal regulators pertaining to patient care issues i.e. legal issues, ethical dilemmas, and provide cost efficient and timely discharge planning processes to decrease financial loss and optimize quality outcomes.
  • Develop and maintain relationships with payors and community agencies to provide appropriate services and access throughout the continuum of care within the system. Develop and maintain positive relationships with nursing homes, sub-acute facilities, transitional living communities, and home health agencies.
  • Track and trend issues regarding payment, placement issues, transportation, etc. in order to effectively work with referral partners for continued improvement of service levels. Demonstrates well-developed skills to proactively manage authorization challenges for care being delivered. Sets up, monitors and aligns departmental processes to minimize hospital’s exposure to denials for care delivered.
  • Interview and select candidates for employment. Orient, train, supervise, direct, schedule and assign work. Outline scope of authority as well as job responsibilities of employees under supervision.
  • Maintains dashboard metrics and analyzes gaps and institutes change in order to optimize case management processes and outcomes.
  • Performs duties as required or assigned by emergency or other operational reasons for which the employee is qualified to perform.
  • Identifying and recommending appropriate staffing levels to achieve the goals of case management.
• * People At The Heart Of All We Do
  • Fosters an inclusive and engaged environment through teamwork and collaboration.
  • Ensures patients and families have the best possible experiences across the continuum of care.
  • Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.
• * Stewardship
  • Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
  • Knows and adheres to organizational and department policies and procedures.
• * Safety And Performance Improvement
  • Behaves in a mindful manner focused on self, patient, visitor, and team safety.
  • Demonstrates accountability and commitment to quality work.
  • Participates actively in process improvement and adoption of standard work.
• * Director/Assistant Director Capabilities
  • Demonstrates accountability for programs and services and/or organization-wide functional responsibilities within the system to support achievement of organizational priorities.
  • Coaches leaders and professional team members to create an environment that encourages continuous learning and development.
  • Engages direct leadership team to leverage talent, communicate a strong vision and mission and achieve buy-in.
  • Directs and participates in leadership team development, performance management and engagement.
  • Leads change by communicating a clear vision, influencing and motivating others, and developing relationships with key stakeholders.
  • Promotes and inspires a healthy and safe culture to advance overall system, team performance and service experience.
  • Maintains patient confidentiality and privacy, and adhere to HIPAA standards.

What You Will Need

Required:

• Master Degree in Nursing, Business, Social Work, or related field
•Minimum 5+ years of successful administrative leadership experience in a community hospital system in Case Management, Social Work, Population Health, Clinical or other related operational leadership role.
•Experience in program development is required
•5+ prior years’ experience in clinical, case management, social work, and/or nurse navigation experience

Preferred:
• 10 years of years of successful administrative leadership experience in a community hospital system in Case Management, Social Work, Population Health, Clinical or other related operational leadership role
• Case Manager Certification preferred with expectations to obtain ACM/CCM certification within 1 year of employment
• Certified Lean Six Sigma Green Belt preferred with expectations to obtain Certified Lean Six Sigma Yellow Belt within 1 year of employment and Certified Lean Six Sigma Green Belt within 2 years.