Director, Care Management

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Master's Degree in Social Work or related field.
2.Licensed Certified Social Worker (LCSW) or Licensed Independent Clinical Social Worker (LICSW) through West Virginia Board of Social Work.

EXPERIENCE:
1. Seven (7) years of social work experience with three (3) years of management experience.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Care Management Certification upon hire or obtained within one (1) year of hire.
EXPERIENCE:
1. Experience with Performance Improvement and Case Management.

CORE DUTIES AND RESPONSIBILITIES:The statements described here are intended to describe the general nature of work being performed by people assigned to this position.They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.Other duties may be assigned.

1. Plans, directs, and supervises all aspects of the care management program.

2. Facilitates growth and development of the care management program consistent with hospital philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, and other activities as needed.

3. Provides leadership focus for coordination and facilitation of care transitions across continuum of care.

4. Creates, tracks, and administers operational and capital budgets in collaboration with managers.

5. Identifies and achieves optimal outcomes via the care management process.

6. Oversees departmental personnel functions and performance management.

7. Acts as liaison to facilitate communication and collaboration between all care partners (e.g. physicians, hospitalists, community care managers, nurses, community resources, etc.).

8. Leads a high-performance team of "system thinkers" who incorporate leadership principles and vision in performing the functions of care management.

9. Uses data to drive decisions, plan, and implement performance improvement strategies for care management.

10. Responsible for overseeing the education of physicians, managers, staff, students, patients, and families related to the care management process.

11. Accountable for the assessment, planning, design, implementation, and evaluation of care management, social services, and transitions of care programs across the continuum.

12. Work closely with post-acute providers to review readmission data and the transition of care process.

13. Responsible for resource utilization program in all areas of hospital's health care delivery. Expected to implement efficient and effective changes to areas of over/under utilization such as treatments, procedures, etc.

14. Collaborate with responsible personnel/departments for responses to payer requests for information related to claims, denials, appeals, and all utilization and quality issues.

15. Collaborate with business office and compliance personnel in the denial process and program management for inpatient, outpatient and observation level of care (LOC) services for effective reduction of denials from all sources and payers.

PHYSICAL REQUIREMENTS:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Even though the weight lifted may be only a negligible amount, a job is rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible.

2. Prolonged periods of standing or sitting.

WORKING ENVIRONMENT:The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office and clinical settings.

2. Traveling to off site and community venues may be required.

3. Flexible hours to include weekends and holidays.

4. May require the ability to take call on a rotational basis.

5. Cognizant of environmental factors, infection control issues, and maintains a safe environment

SKILLS AND ABILITIES:

1. Must possess computer skills needed to obtain data for tracking, trending and analysis.

2. Possesses excellent interpersonal communication and negotiation skills in interactions with patients, families, physicians, and healthcare team colleagues. Excellent written and verbal communication skills.

3. Ability to work with people of all social, economic, and cultural backgrounds and be flexible, open minded, and adaptable to change.

4. Demonstrates expert team building skills, problem solving abilities, and conflict resolution strategies.

5. Knowledge of leading practice in clinical care and payer requirements.

6. Knowledge of payer mechanisms, clinical utilization, discharge planning and transitions of care.

7. Ability to relay information and deal tactfully and harmoniously with others.

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center:

Address:

WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.