Director, Utilization & Care Coordination

    Hackensack University Medical Center
    1350 Campus Parkway, Wall, NJ 07719
    Full-time, Part-time
    Refer friends, get paid!

    Job Description

    Overview

    How have you impacted someone's life today? At Hackensack Meridian Health our teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career, all within New Jersey's premier healthcare system.

    Responsible for strategizing with other leaders and physicians within the Hackensack Meridian University Health Network to improve the efficacy, efficiency and effectiveness of health care delivered to patients within their assigned region of the Hackensack Meridian Health Network. Provides leadership and strategic direction for the development and oversight of Utilization. Review throughout the network and Clinical Documentation Improvement Program to physician practices participating in the Clinically Integrated Network. Provides leadership and direction to support consistent practice and outcomes involving clinical operations and associated revenue cycle activities including development/expansion of the network-wide Clinical Documentation Improvement Program to physician practices participating in the Clinically Integrated Network.

    Responsibilities

    A day in the life of a Director, Utilization & Care Coordination at Hackensack Meridian includes:
    • Accountable for oversight and leadership of southern Hospital Care Management teams.
    • Develop, implement, and oversee policies, procedures, and processes to promote and improve clinical program operations.
    • Enhance clinical documentation initiatives to support the severity of patients' illnesses, enhance communication among care-givers, advance publicly available quality and safety metrics and improve the appropriateness of reimbursements.
    • Ensure compliance with the requirements of the systems utilization review plan, state and federal regulations & Payer requirements for reimbursement system wide.
    • Provides leadership and direction to support consistent practice and outcomes involving clinical operations and associated revenue cycle activities including development/expansion of the network-wide Clinical Documentation Improvement Program to physician practices participating in the Clinically Integrated Network.
    • Manages and/or assists in the recruitment, development and supervision of team members for the southern region, network CDI teams and centralized Utilization Review.
    • Continually reviews technology, assesses needs and makes recommendations for program development.
    • Meets with physician leaders in development of processes and protocols to prevent denials and improve transition of care for service line management of patients.
    • Coordinates and directs the development and implementation of annual operating and capital budgets related to areas of responsibility.
    • Introduces innovative ideas for care coordination, utilization review and CDI; gains consensus across the continuum of care with ability to carry out proposed implementation plans.
    • Responsible for oversight of the southern region care coordination, social work and utilization review department's processes in accordance with federal, state, and local standards, guidelines and regulations with in their region.
    • Supports the individual hospital and regional initiatives for improvement in patient satisfaction scores and patient outcomes.
    • In collaboration with other leaders, makes recommendations for educational programs to enhance understanding and cooperation in transitions of care.
    • Strategizes with site Managers to assist with meeting patient discharge planning needs, psychosocial needs, insurance reviews constraints and patient status assignment.
    • Collaborates with the Director of the ACO and Specialty areas to enhance communication and coordination of bundle and ACO patients to ensure quality and finical targets are met.
    • Makes recommendations for improvements in system management of information relative to Care Coordination, Social Work and Utilization Review. Able to interpret and provide meaningful data related to Case Management activities.
    • Assures site leaders are knowledgeable and compliant with all applicable laws and regulations for assigned areas within the region and remains up-to-date with the most recent changes that affect local practice.
    • Works with Capacity Management, Patient Placement and the transfer center to assist in activities related to patient throughput within and out of the medical center and health network.
    • Partners and maintains relationships with post-acute and community agencies to improve transitions across the continuum and address social determents of health for their population.
    Qualifications

    Education, Knowledge, Skills and Abilities Required:
    • Master's Degree in Nursing, healthcare administration, social work business administration or related field.
    • Minimum of 7 years of management experience.
    • Knowledge of healthcare principles.
    • In-depth, working knowledge of state and national regulatory guidelines.
    • Strong leadership, financial management and strategic planning skills.
    • Strong written and verbal communication.
    • Knowledge of information technology and management of information systems.
    • Ability to oversee activities in a large integrated department.
    • Comfortable with technology, in the Microsoft office suite of products including Outlook, Word, Excel and Power Point.
    • Knowledge and understanding of the revenue cycle.
    • Highly accountable, self-starter; strong sense of urgency; can work autonomously with limited direction
    • Balances strategic ability with an affinity for operations; not afraid to dig into the details of the work to influence a positive outcome.
    • Experience with quality improvement methodology, practice and execution.
    • Strong persuasion and presentation skills; the ability to lead multi-disciplinary groups to action and desired outcomes.
    Licenses and Certifications Preferred:
    • Certified Case Manager
    Our Network

    As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.

    Posting ID: 559419282Posted: 2020-06-17