Director of Care Coordination

Overview

Natividad is seeking a permanent full-time Director of Care Coordination (RN) in the Utilization Management Department. Under general direction, the Director of Care Coordination is responsible for the administration of Acute and Ambulatory Care Management and Utilization Review at Natividad. This position directs the Utilization Review (UR) & Social Services (SS) departments; develops policies and procedures for adherence to government, accrediting agency, and third-party payer standards; provides administrative support to designated physician committees; educates professional and medical staff on acute and ambulatory care management, utilization review, and transition of care practices.

Specific Skills

Will have proven track record demonstrating the following knowledge, skills, and abilities: Thorough knowledge of:

Population health management, program development, and implementation in both acute and ambulatory settings.
Medi-Cal regulations addressing prior authorization, concurrent review, and reimbursement.
TJC, Department of Health AND Human Services’ Centers for Medicare and Medicaid Services (CMS), DHCS, and regulatory standards and requirements pertaining to patient care, acute and ambulatory care management, utilization review, discharge planning, and reporting requirements.
Hospital Ambulatory Services Routines
Common disease stages, sequences, progression, processes found, and resulting treatment plans frequently followed, in acute, ambulatory, and extended-care settings.
Principles, practices, and theories of case management, utilization review, and discharge planning.
Private payor reimbursement practices and procedures.

Skill and Ability to:

Plan, develop, implement, and manage Medicare waiver programs including pay for reporting, pay for performance, and full risk programs to support population health programs.
Plan, organize, coordinate, direct, and develop the hospital-wide functions and staff of an acute and ambulatory care management team to effectively drive change.
Supervise, educate, train, coach, and evaluate acute and ambulatory care management team members in UR & SS departments
Analyze complex data and trends, recognize causal relationships, and derive conclusions.
Build consensuses, resolve conflicts, and develop collaboration between multidisciplinary teams.
Compile and interpret data, and prepare and present clear, concise, accurate reports and action plans.
Operate computer software applications and hospital-specific programs in the performance of work duties.
Communicate proficiently, effectively, and tactfully, both orally and in writing, in the performance of job duties.
Establish and maintain cooperative, effective working relationships with medical staff, coworkers, and all others contacted through the course of work
Evaluate program effectiveness continuously and identify optimization opportunities in a rapidly changing environment.

Responsible For

Plans, develops, implements, and manages Natividad’ s Acute and Ambulatory Care Management functions to align with population healthcare needs.
Develops hospital-wide policies and procedures ensuring compliance with The Joint Commission (TJC) and other regulatory agencies.
Manages UR & SS staff and supervises daily operational activities; project planning/development; facilities planning; budget preparation; regulatory compliance; maintenance of department policy and procedures manuals, files, records, and correspondence; equipment selection and maintenance; supply ordering; and vendor contract negotiations.
Provides responsible UR & SS resource/fiscal management to ensure continuous productivity, process improvement, improved customer satisfaction, and achievement of department goals, objectives, and financial improvement.
Serves both as a member and administrative staff to the Utilization Review Committee, Patient Care Team, and Patient Safety Quality Council.
Acts as liaison for Natividad between third-party payers, California Department of Health Care Services (DHCS), TJC, County Health Department, and other regulatory and community agencies in promoting collaborative working relationships and assisting with improvement of patient flow and quality of patient care and services.
Reviews and analyzes standards and requirements established by regulatory agencies and third-party payers which govern inpatient admissions, treatments, continued stays, discharges, and transitions of care.
Identifies, assesses, and creates an action plan to resolve interdepartmental matters affecting care management.
Educates, trains, and serves Natividad staff as subject matter expert resource on current acute and ambulatory care management, utilization review, discharge planning, transition of care, and complex care-management methodologies, requirements, and criteria.
Works collaboratively with Natividad Human Resources regarding recruitment, retention, development, training, and performance management.

Additional Requirements

CONDITIONS OF EMPLOYMENT

Natividad requires that all incumbents pass a pre-employment physical/medical assessment.
Natividad will conduct a thorough background and reference check process, which includes a Department of Justice fingerprint check.
Employees who drive on County business to carry out job related duties must possess a valid CA Driver License for the class vehicle driven.
Employees must have and show their original Social Security Card and a valid CA Driver License or CA State ID prior to the first day of work.
Incumbents may be required to work all shifts, including weekends and holidays; and work with potentially hazardous and infectious substances.

Job Nature

Full Time

Educational Requirements

Any combination of training, education and/or experience which provides the knowledge, skills and abilities and required conditions of employment listed above is qualifying. An example of a way these requirements might be acquired is: Education: Completion of an accredited nursing program with a valid California Registered Nurse License (Required)

AND

Experience: Three (3) years’ experience as a Care Coordinator for Case Management Nurses in acute and ambulatory settings, with at least one (1) year performing at a supervisory or management level.

Five (5) years’ experience as a Registered Nurse in an acute-care hospital setting on a Medical/Surgical unit, with at least two (2) years performing in a charge nurse capacity.

Experience Requirements

Three (3)

Job Location

Natividad Medical Center 1441 Constitution Blvd. Salinas, CA

Salary

$81.94 - $111.91 Hourly $6,555.20 - $8,952.80 Biweekly $14,202.93 - $19,397.73 Monthly

Other Benefits

http://www.co.monterey.ca.us/government/departments-a-h/human-resources/human-resources/benefits/benefit-summary-sheet

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