Director of Case Management

The Director of Care Management will provide leadership and consultation in all aspects of care management, as well as develop, implement, direct, and evaluate an operational plan for care management that is in alignment with the organizational strategic plan to ensure that processes meet or exceed regulatory and industry standards.
Responsible for the planning, development, implementation and operations of Care Management.
The care management program is essential to ensure that care is coordinated across the continuum as needed, to ensure smooth transitions to the appropriate level of care and services; and ensure a quality patient experience.
The position has oversight for all aspects of daily operations to enable long-term and short-term goals to be achieved in a manner that is consistent with the mission values and strategic goals across the Health System. The Director is accountable for achieving established outcomes through actively engaging interdisciplinary teams and external stakeholders.

Key Duties and Responsibilities:

• Ensures highly effective operations for departments that provide Access, Utilization Review, Care Coordination and Discharge Planning by program development, process improvement, and coordination of processes across all functions.
• Develops structures and processes that contribute to continuity of care through demonstrated use of the interdisciplinary team approach to patient care. Works collaboratively with internal and external resources and agencies, physicians and all members of the interdisciplinary team in meeting customer needs and organizational goals.
• Creates data priorities and establishes dashboards for monitoring outcomes.
• Develops, implements, and operates an evidence-based, state-of-the-art care management program which supports Moffitt's mission and vision.
• Develops and implements effective patient centered, interdisciplinary models of care management in a rapid, sustainable manner, achieving strategic quality, safety and utilization goals in a patient and family centered manner.
• Provides effective utilization management programs and supports effective collaboration with payers.
• People - Recruits, develops, evaluates, recognizes. Rewards, and retains the right number and type of staff; Continuously engages staff in the identification and resolution of staff satisfiers and dissatisfies.
• Growth - Establishes and monitors departments' productivity measures; Maintains the departments' budgets and is a good steward of resources; Ensures operating expenses and/or net margin are within targets.
• Quality - Sets high standards for department programs and services, including the achievement of efficiency and effectiveness targets; Creates a climate of continuous improvement and demonstrates improvement over time; Maintains compliance with regulatory requirements.
• Innovation - Establishes the departments' strategic direction supporting the organizational strategic plan; moves the department to the next level of performance through groundbreaking innovation and new ways of doing business.
• Service - Actively seeks information about internal and external patient/customers/team members, as well as produce positive outcomes.
• Provides professional oversight and management of professional practice of case management.
• Responsible for case management, outpatient home health, placement and hospice referrals; responsible for inpatient hospice referrals. Establishes and maintains contracts and PO's to pay for these services for indigent patients and assures quality care across the continuum.
• Responsible for case management staff that lead the discharge process and facilitate referrals for home health, home O2, DME, and skilled and custodial placements.
• Ensures that utilization, LOS, and other quality metrics are communicated to staff and process are developed and maintained to ensure adherence to set performance targets.
• Ensures that the in-patient CM coordinates care effectively and efficiently with the medical teams. Ensures adequate patient to staff ratios and that staff have adequate resources.
• Reviews data and prepares reports on utilization, LOS, acuity, and discharge process.
• Ensures compliance with federal, state, and professional/accreditory regulations, including CMS, TJC, Dept. of Health, NCI, COC, etc.
• Responsible for utilization review process and the authorization of in-patient services. Monitors denial rate and appeal processes. Ensures timely authorization for payment for multiple payors and that denied services are communicated to care team.
• Ensures highly effective operations for departments that provide Access, Utilization Review, Care Coordination and Discharge Planning by program development, process improvement, and coordination of processes across all functions.
• Creates a positive culture which is patient centered, collaborative and achieves Moffitt's aim, goals and outcomes.
• Collaborates effectively with care managers, department leaders, physicians and system leaders to effectively implement the programs.
• Demonstrates effective communication with care managers, department leaders, physicians, system leaders and external stakeholders.
• Creates a patient and family centered culture and supports high performance of interdisciplinary team.
• Establish effective relationships with external agencies providing services to the organization (such as vendors, care providers, etc.).
• Effectively collaborates and communicates with caregivers, managers, physicians and leaders while developing, implementing and operating the program.
• Review all regulatory requirements to ensure high quality, safe, and cost-effective care.
  a) Identify barriers to care progression.
  b) Troubleshoot barriers to identify and track delay trends, and facilitate a smooth and timely transition through the system.
  c) Communicate and document relevant information to physicians, care team, patients and families regarding potential issues or barriers to discharge. Escalate discharge barriers to manager.
• Identify patients with high risk concerns for presentation at Clinical High Risk meeting based on experience, high risk report or denials.
• Follow up on actions and report new or unresolved concerns with manager
• Develops and implements the staffing, education, mentoring, information technology and data needed to enable care management teams to effectively provide patient-centered care management.
• Identify patients with high risk concerns for presentation at Clinical High Risk meeting based on experience, high risk report or denials

Minimum Experience:

5 years of experience in an academic/acute care health care institution, with a minimum of 3 years of management experience. Experience managing Case Management operations. Strategic and analytical thinking; good time management; ability to influence others; ability to prioritize and provide clear direction; ability to coach and develop staff; ability to listen well; excellent problem-solving skills; visionary and innovative.
Case management principles and expected outcomes.
Principles of utilization review.

Education Required:

Master's Degree