Director Care Management

Job ID: J120040
Company: West Penn Allegheny Health System
Location: Pittsburgh, PA, United States
Facility: Allegheny General Hospital
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

GENERAL OVERVIEW:

Studies, evaluates, selects and implements systems to facilitate entry of acute care patients to the appropriate facility.  Once implemented, evaluates effectiveness and leads improvement efforts system wide to provide an effective admission structure.

Develops and implements strategies with internal and external providers to ensure we are able to place patients in the right level of care at the right time predictably.  Works closely with VP, Care Management to assure consistent practice across the health system.

Serves as a resource and mentor to the Care Management director team.  Assumes responsibility for implementing new care management processes across the system in response to changes in external health care and payer environment. 

Studies and implements the case management model and structure to achieve sustaining appropriate length of stay, resource utilization, and clinical outcomes for patients over time.  Responsible for designing and implementing improvement strategies for the care model on an ongoing basis.

Oversees all activities related to referral management.  Develops collaborative relationships with payers and maintains compliance with payer contracts for utilization management.

Leads initiatives to design and implement strategies to manage appropriate admissions and lengths of stay during all phases of inpatient segment of the continuum of care.

Acts as a resource and provides ongoing education for department staff as well as system care management leaders, and the organization regarding national and regional trends; adjusts case management model to meet financial, regulatory and clinical goals for AHN in collaboration with the VP Care Management.

Develops annual budget for areas of responsibility and works with department leaders and staff to implement the budget. Assures measures for staying within budgetary parameters.  Works closely with hospital leadership to plan budgetary needs annually.

Leads development and implementation of strategies related to management of longitudinal care for patients connecting the pre and post acute care with the short term acute care setting.

Works closely with hospital leadership to develop a 5 year plan for areas of responsibility including implementation plans, timeline projections, financial projections, etc.

QUALIFICATIONS:

Education:

Master’s Degree in Nursing or related health care field (Required)

Case Management certification (Preferred) 

Licenses/Certifications:

Current license to practice nursing in Pennsylvania

Experience and Skills

Ten (10) years of acute care case management experience required, preferably at a tertiary care center and/or health system. (Required) 

Five (5) years of progressive management experience. (Required)

3-5 Years of experience with regulations and health finance related to management of patient care. (Required) 

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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