Description

Purpose:
The Director provides administrative and personnel management for the Clinical Care Coordination and Discharge Planning Department. Provides leadership within the organization for continuous improvement in medical management, clinical resource utilization, cost control and cost effectiveness to achieve optimal hospital reimbursement for services provided. Functions as a liaison to external agencies and vendors who provide care in the post hospital setting. Functions as a liaison to insurance companies to create and maintain effective working relationships and positive outcomes in the medical management and reimbursement of our patients.

Responsibilities:

• - Participate as a member/leader of various committees to ensure that actions and issues are consistent with the CM Program goals and objectives. - Establish care management goals in collaboration with the Medical Director, /medical leadership, car
• Directs all activities and process related to daily operations.
• Provides oversight of the Clinical Care Coordination and Discharge Planning Department operations, keeping leadership well-informed of current operations, barriers which are impacting length of stay, bed capacity issues, complaints, and overall operational processes.
• Overall responsibility in management of the activities relating to the monitoring of utilization of resources, efficient proactive discharge planning to ensure effective movement of patients across the continuum of care.
• Respond to department wide staff and staffing issues and needs relative to vacancies, complaints, scheduling, recruitment, and position justifications as appropriate.
• Establishes and monitors performance and provides feedback and guidance to staff. Conducts annual performance evaluations.
• Facilitate determination of benchmarks for clinical and services monitors in conjunction with Department and System leadership.
• Create Discharge Planning goals in collaboration with senior leadership.
• Ensure that monitoring and education processes are supporting the achievement of the targeted goals and objectives of the department.
• Ensure maintenance of operational efficiency for all areas of responsibility to promote compliance with standards of the JCAHO, regulations of state DOH, as well as other regulatory agencies
• Direct activities relating to special projects for utilization management, resource consumption, and ensuring movement of patients efficiently across the continuum of care
• Ensure compliance with work plans and goals.
• Provide day-to-day departmental management.

Qualifications

Qualifications:

• Master's Degree and minimum of five years experience in discharge planning or care coordination, or similar experience managing departmental operations.
• Commensurate leadership experience of two years or more.,
• Strong knowledge of clinical care, discharge planning processes, and current regulations relative to utilization, clinical care coordination, and discharge planning
• Ability to build credible and effective relationships with physician leadership
• Ability to prepare and critically analyze data, make appropriate recommendations toward resolution, and follow-through of identified action Expertise in interpersonal relationships, organizational relations
• Effective communication, negotiation, and conflict resolution skillsStrong analytical and critical thinking skills
• Demonstrated leadership capabilitiesStrong quality improvement expertise
• Knowledge of health care revenue cycle processes and requirements

Licensure, Certifications, and Clearances:

• Act 33, 34, 73 clearances required or obtained within 30 days of hire.
• Licensure: RN, LSW/LCSW, or education-appropriate license required
• Certification: CCM/ACM required
• Accredited Case Manager OR Certified Case Manager (CCM)
• Cardiopulmonary Resuscitation (CPR)
• Act 33 with renewal
• Act 34 with renewal
• Act 73 FBI Clearance with renewal

UPMC is an Equal Opportunity Employer/Disability/Veteran

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