Director Care Management

Description Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work? Director Care Coordinator The Director is responsible for providing leadership, planning, managing and monitoring of the outcomes of the Care Management staff (Case Managers, Utilization Managers, Physician Advisors and Denials Coordinators). The Director identifies improvement opportunities and facilitates process standardization to promote outcomes in alignment with the strategic and operational goals of Penn Medicine Princeton Medical Health by maximizing resource utilization and improving organizational efficiencies. The Director ensures the discharge planning process is responsive to patients' needs by monitoring the inpatient and post-acute effectiveness of the process and tracks readmissions to identify preventable readmissions and potential problems in the process. The Director leads performance improvement initiatives to improve clinical management of the continuum of care process, length of stay, denials management, and status of patients. The Director serves as the primary point of contact with community post-acute providers including skilled nursing facilities, rehabilitation hospitals, specialized post-acute services, home health care agencies, durable medical equipment providers, and hospices. The Director also monitors the effectiveness and performance of post-acute services. Responsibilities: Establishes and standardizes defined policies, procedures, and processes to optimize efficiency and maximize productivity. Collaborates with all departments at Penn Medicine Princeton Health in assuring patients are transitioned to the optimal level of care, in the right setting at the right time. Leads Care Management inpatient and PAC performance improvement initiatives and collaborates with all disciplines and departments to implement process improvements. Oversees the maintenance of the High Performing Skilled Nursing Facilities Network ensuring appropriate review of performance, membership, level of participation and progress to goals. Ensures appropriate certification and reimbursement by third party payers, including monitoring departmental procedures and interface with third party payers for hospital-based patients. Identifies and evaluates changes in third party payer policies and procedures; communicates changes to hospital leadership, Care Management staff, Nursing Leadership and Medical Staff. Collaborates with the Chair, Utilization Management Committee and hospital leadership to set annual priorities and goals for the department. Assists in developing innovative care management programs across the system. Collaborates with the department's Inpatient Care Management Medical Director and Physician Advisors regarding complex cases, third party payer issues, and interaction with Care Coordinators and Social Workers. Ensures that all staff understands and integrate caring service standards into their interaction with patients, families, and other employees. Plans orientation and continuing education of staff. Education: Bachelor's degree in nursing (BSN) - required Master's degree in nursing (MSN) or another related healthcare field - preferred Registered Nurse - NJ (Required) Case Management certification preferred; or obtains within 2 years of employment Equivalent Experience: 3-5 years managing a Care Management program in an acute care facility - required Specialized Skills: Knowledge of CMS Condition of Participation regulations and The Joint Commission Standards Joint Commission Understanding of health care continuum and care coordination competencies. Exceptional customer service and organizational skills Excellent relationship-building skills. We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives. Live Your Life's Work We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law. REQNUMBER: 226481

Created: 2024-10-19