Corporate Director Case Management and Social Work bei Centra Health, Inc

• Responsible for oversight of the Case Management and Social Work Departments in Acute Care facilities. 
• Direct the operations of the Case Management and Social Work Departments from a system approach, while leading and coordinating key strategic and functional services to support departmental, facility, and organizational goals. 
• Establishes system performance expectations for the department and provides direction, feedback, and guidance to employees. 
• Ensures that department/functional operations across the system are in full compliance with accrediting and regulatory agency standards.
• Develops and implements system departmental policies and procedures across all case management and social work departments.
• Routinely audits and tracks for quality assurance, analyzes data to identify opportunities and acts upon data. 
• Analyzes patient data and case management outcomes from a system approach to identify trends, inefficiencies, and areas for improvement in transition of care/discharge planning and utilization review. 
• Holds staff accountable to follow care management processes to support quality and compliance.
• Supports national standards for case management scope of service: Education, Care Coordination, Compliance, Transition Management and Resource Utilization.
• Collaborates with case management managers and others across the system to achieve standardized practices and processes related to case management including readmission prevention, use of predictive readmission tool and application of appropriate interventions,   length-of-stay management, denial prevention related to medical necessity through proactively addressing barriers to care transitions (including tracking of avoidable days/delays), daily team rounding, and patient satisfaction related to care transitions. 
• Works closely with community health, ambulatory and population health partners in efforts to support patients across the care continuum.
• Collaborates with external and internal ambulatory and post-acute providers/staff to ensure seamless transitions of care.
• Works closely with post-acute network partners on key initiatives and efforts to reduce unnecessary post-acute care utilization, when safe and appropriate.
• Participate in development and management of a system post-acute provider network.
• Leads a regular cadence of meetings with post-acute partners to analyze data and trends, discuss concerns, and increase collaboration.
• Coordinates and monitors the development of long-range plans and annual budgets for Case Management and Social work departments in the acute care facilities.
• Leads the implementation and oversight of the Utilization Management Plan using data to drive hospital utilization performance improvement.
• Leads system Utilization Management Committee.
• Partners with facility and system physician leaders to optimize the Utilization Management Committee, providing actionable data related to utilization opportunities identified through qualitative data, and quantitative data
• Manage department operations to ensure effective throughput and reimbursement for services provided.
• Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with governmental regulations and organizational policy.
• Coordinates education opportunities for case management personnel & physicians regarding continuum of care, reimbursement, regulations, and care issues.
• In collaboration EVP, Chief Physician Executive, provides oversight to the physician advisor program.
• Monitor and evaluate effectiveness of physician advisor program on a system level including status determination, peer to peer outcomes, and productivity.
• Provides support to system Clinical Documentation Improvement program through oversight of physician advisor program.
• Demonstrates ability to make decisions, balancing needs of the patient, within confines of various internal and external factors
• Demonstrates knowledge of federal state Medicare/Medicaid and other regulations affecting reimbursement utilization and discharge planning
• Demonstrates knowledge of insurance/government/contracts reimbursement methodologies
• Demonstrates knowledge of InterQual and multiple criteria sets and able to apply to patient populations.
• Develops and implements strategies to improve workflows and processes/procedures to enhance the utilization review program.

Other Functions:

• Performs other duties as assigned.

Required Qualifications:

• Five years of progressively responsible leadership experience in healthcare.
• Five years of Case Management and Utilization Review experience.
• Bachelor's degree in nursing from an accredited institution.
• License to practice as a registered nurse in the Commonwealth of Virginia.
• Case Management certification.

Preferred Qualifications:

• Master’s degree in nursing or related field.