Regional Director Care Management Nursing

Day-Weekend (United States of America)

9100 W 74TH ST

SHAWNEE MISSION

Kansas

66204

Develops and oversees programs that monitor resource utilization, patient care coordination, denial avoidance, and optimal patient care transitions for the region. Creates and oversees implementation of organizational strategies to accomplish length of stay goals, including organizing and facilitating interdepartmental teams with leadership across the market. Builds collaborative relationships with CMOs, CNOs, Physician leaders, Care Management, Revenue Cycle leaders, and other functional leaders to optimize the clinical revenue cycle. Serves as a subject matter expert for Care Management, Transitions of Care, and Care Coordination, partnering with AIT and cross functional teams to build effective strategies. Serves as a consultant for regional and campus Executive Teams regarding Care Management, Social Services, Care Coordination, Transitions of Care, and the Post-Acute Care Collaborative. Exercises primary responsibility for the annual review and approval of the regional Utilization Management Plan by the appropriate medical committee, administration, and the Governing Board. Provides regional oversight and direction for the implementation and sustainment of Care Management Best Practice initiatives and standard work. Develops strategy for the expansion of the transition of care program in collaboration with other programs to achieve the metric goal of decreased unnecessary readmissions. Evaluates, monitors, and ensures compliance with all Care Management related federal and state regulations including, but not limited to CMS CoP for Discharge Planning and The Joint Commission and/or DNV. Leverages reports and dashboards to monitor the effectiveness of the Care Management program and create strategies to improve outcomes. Collaborates with regulatory and public policy departments to advocate for hospital and government entities to improve public policy and regulations. Provides leadership and management of the development and adherence of an annual operational and capital budget for areas of responsibility. Serves as a transformational leader and develops and monitors strategic plans and implementation for driving care coordination in a cost-effective and consumer-centered manner. Other duties as assigned.Knowledge, Skills, and Abilities:
• Management and leadership experience in Care Management.
• Knowledge of Medicare and Medicaid rules and regulations, payment systems and commercial contracts.
• Knowledge of Interqual and/or Milleman criteria sets.
• High-level knowledge of Clinical Documentation Integrity.
• Working knowledge of disease management and resource utilization.
• Excellent presentation and interpersonal communications skills, both written and verbal.
• Ability to concisely and accurately communicate complex concepts to non-Care Management professionals.
• Demonstrated ability to prioritize responsibilities, measure progress and validate accountabilities against those metrics.
• Excellent relationship builder, change agent and problem-solving skills.
• Proven ability to motivate, lead and build teams effectively to pursue operational excellence to achieve desired metrics that are in alignment with the organization’s vision and values.
• Knowledge of industry standards related to Joint Commission, CMS, OSHA, regulatory standards for area of responsibility.
• Knowledge of managed care contracting and standards, medical necessity, and precertification experience, both hospital stay and care transition issues.
• Knowledge of home health, skilled nursing, and rehabilitation setting as related to coordination of care across the continuum.
• Ability to manage multiple priorities from campus, regional, divisional and corporate levels.
• Able to adapt quickly to change and be able to coordinate efforts across multiple stakeholders.
• Computer skills and proficient in Microsoft Office Products.

Education:
• Master's of Nursing [Preferred]

Field of Study:
• Registered Nurse with a Master of Science in Nursing (MSN)

Work Experience:
• 10+ registered nurse: minimum of ten years of clinical nursing experience in an acute care hospital. [Required]
• 5+ leadership experience in the field of case management/utilization review, and social services/social work. department(s) may include but not limited to: director of resource management, director of care coordination, or director of case management and social services. [Required]
• Case Management leadership experience in a multihospital system, community-based, rural-based, and academic hospital settings [Preferred]
• CDI and or ICD-10 training, and or high level knowledge of coding principles in the hospital inpatient and outpatient settings. [Preferred]

Additional Information:
• N/A

Licenses and Certifications:
• Registered Nurse (RN) [Required]
• Driver's License (DL) [Required]
• Certified Case Manager (CCM) [Preferred]

Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements - https://tinyurl.com/msy4mja2

$104,795.46 - $194,919.56

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.