Job Description

Job Title: Director, Health and Care Management (Licensed Social Worker -or- Registered Nurse)
Job ID: 713035
Status: Full-Time
Regular/Temporary: Regular
Hours: Daylight, Monday thru Friday
Shift: Day Job
Facility: UPMC Horizon
Department: HRZ00 - Care Management
Location: 110 North Main Street, Greenville PA 16125

Description

Are you an experienced, dynamic social work or nursing leader with extensive experience within the field of Care Management? Put your skills to the test! UPMC Horizon is hiring a full-time Director of Health Management to provide leadership over the Care Management department for both of UPMC Horizon's campuses located in Shenango and Greenville.

In this role you will provide supervisory support to a team of both social workers and nurse care managers.

This position will work daylight hours Monday through Friday, but will maintain 24 hour accountability for the department.

As Director, you will be responsible for the development, implementation, and management of an integrated care coordination and health management system. This system facilitates the promotion, monitoring and continuous improvement of quality of care, quality of service, health care outcomes, patient/family satisfaction and utilization management across the continuum of care. You will have oversight of all managed care objectives, initiatives and contracts.

Does this sound like the perfect fit for you? Apply today!

Responsibilities:
  • Assists the Case Management Team in various functions to include preparing, disseminating reports and maintenance of records. Serves on Committees as appropriate.
  • Assists with coordinating the development of contracts to support Case Management activities
  • Coordinate the development and implementation of administrative policies, procedures, and systems related to health management.
  • Decisions reflect understanding of customer needs quality of care in a managed care environment
  • Design tools and systems to facilitate and optimize the care coordination and health management processes across the continuum of care.
  • Develop methods for clinical and financial analysis to measure, monitor and evaluate systems, practice pattern, utilization management and care coordination against established goals, standards or benchmarks in areas of cost, qualify of care, qualify of service, outcomes, measures, and patient satisfaction.
  • Direct development, implementation, monitoring and improvement of clinical pathways, clinical guidelines, utilization review, and outcome measures and related education systems.
  • Direct the health management program and works with the Medical Director in program planning, goal setting and policy development to support hospital and network mission and strategic plans, particularly managed care contracts and initiatives.
  • Implement and maintain a quality assurance program for the health management programs including collaboration with quality assurance and improvement and risk management.
  • In conjunction with Medical Director and Education Department, develop and implement educational programs related to care coordination and health management for physicians, care providers, and hospital employees.
  • Maintain fiscal accountability for areas of responsibility.
  • Maintains current information regarding national, state and local programs related to community resources
  • Manage assigned personnel including recruitment, development and evaluation of practice and performance
  • Manages staff carrying out Case Management duties of precertification admissions, concurrent medical record review including monitoring criteria and standards, and coordinating the unit based transitional planning conferences
  • Monitor compliance of care coordination and health management practices with internal and external regulatory requirements, laws, policies and procedures, and contracts.
  • Prepares reports for the Medical Staff and management as appropriate
  • Responsible for following the mandatory reporting procedures for any incident or serious event that did affect or potentially could have affected the clinical care of any patient
  • Serve as a liaison and resource to promote understanding, integration and implementation of care coordination and health management across the hospital, and with clients and key partnerships and networks.
  • Serves as liaison to physicians and departments to maintain quality of care and case management concerns
  • Supervises and participates in the development and implementation of clinical pathways, including the collection of and monitoring of the data
  • Supports Medical Director and Clinical Medical Consultants in analysis, development, implementation and evaluation of outcomes and systems improvements across the care continuum.
  • Work with directors and managers in hospital and ambulatory care settings to facilitate the operations of care coordination and health management program.

Qualifications

  • Knowledge of clinical theory or business management normally acquired through a Masters degree in management or health related field.
  • Knowledge of clinical practice and personnel management normally gained through a minimum of 5 years of progressively responsible experience including supervision.
  • Broad knowledge of health care provider and payment system including understanding of hospital and ambulatory operations, disease management and insurance experience.
  • Interpersonal skills necessary to effectively interact with medical staff, directors, managers, patient care providers, representatives of external agencies, and patients in hospital and ambulatory care settings.
  • Oral and written communication skills necessary to effectively communicate goals and objectives, resolve interdepartmental and interpersonal issues, and compose reports.
  • Effective presentation skills required.
  • Analytical ability necessary to identify appropriate solutions to complex issues and to evaluate data with regards to resources, operations, care and utilization management.
Licensure, Certifications, and Clearances:
  • Act 33 Child Clearance with Renewal
  • Act 34 Criminal Clearance with Renewal
  • Act 73 FBI Clearance
  • Clinical Social Worker or Licensed Social Worker or Registered Nurse
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $0 to $0

Union Position: No

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