Director of Care Coordination (Utilization Management Coordinator) – RN
Overview
Natividad is seeking a permanent full-time Director of Care Coordination 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.
- 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
**REQUIRED APPLICATION MATERIALS AND SCREENING PROCESS**
The screening process is tentative. Should a change be made, applicants will be notified. The competitive process includes:
APPLICATION SUBMISSION: A completed Monterey County Application and responses to the Supplemental Questionnaire, must be to the Natividad Human Resources Office, 1441 Constitution Blvd., Bldg. 300, Salinas, CA. 93906 OR on-line applications may be submitted at www.natividad.com Optional resume may be attached to the on-line application or emailed separately to: SellanAM@natividad.com, resume will be accepted in addition to, but not in lieu of the required application materials. For more information or to receive application materials, you may contact the Natividad Human Resources Office at (831) 783-2700. Office hours, M - F, 7:30a.m.- 5 p.m.
QUALIFICATIONS APPRAISAL: All licenses/certificates will be verified via primary source. Completed application materials will be competitively evaluated. Please note: The initial screening for this position uses ONLY the applicant's answers to the Supplemental Questions. Screeners (who are Subject Matter Experts) are not given the application and/or resumes at this point in the process. Therefore, your answers to the Supplemental Questions are critical. The best-qualified applicants will be invited to participate further in the process.
QUALIFICATIONS ASSESSMENT: To further assess applicants' possessions of required qualifications, this process may include an oral examination, pre-exam exercise, performance exam, or physical ability exam.
ELIGIBLE LIST: Applicants successful in the Qualifications Assessment process will be placed on an eligible list for possible final selection interview. This eligible list will be used to fill current and future vacancies.
SPECIAL NOTES
- If you believe you possess a disability that would require test accommodation, please contact the HR Analyst for Natividad at (831) 783-2711.
- Employment is contingent upon acceptable documentation verifying identity and authorization for employment in the United States.
- If you are hired into this classification in a temporary position you will not be eligible for the benefits.
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.
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.
OR
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
How to Apply
Interested candidates can send their resumes to NMC-HR-Recruitment@natividad.com mentioning "Job Title" in the subject line.
Apply Online