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Director Case Management

Providence Health & Services

Santa Monica, CA 90407
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Job Details

**Providence is calling a Full time, Day shift Director Case Management to Saint Johns Health Center in Santa Monica, CA.**
**We are seeking a Director Case Management** who will promote and support the mission, vision and objectives of Saint John's Health Center and is responsible and accountable for the clinical, fiscal, and personnel management of Case Management on a 24 hour, 7 day basis. Develop and utilize mechanisms for directing, evaluating and controlling operational activities towards accomplishments of division effectiveness and efficiency. Develop collaborative relationships with physicians and all departments. Participate in the development of strategic plans and programs. Assure compliance with all state and federal laws and other regulatory requirements, in all areas of responsibility.
**In this position you will have the following responsibilities:**
+ Prioritize and direct implementation of short and long term goals to support the division and hospital fiscal objectives
+ Prepare annual budget for areas of responsibility and controls operational activities towards accomplishment of departmental efficiency
+ Analyzes budget variances monthly, and prepares reports
+ Ensure continuity and follow-through in daily operations
+ Control expenditures to within division-wide budgeted amounts
+ Facilitate optimal utilization of personnel and material resources
+ Proactively identifies and initiates cost reductions strategies and efficiencies
+ Interview and hires staff who have the skills, knowledge, and values consistent with SJHC
+ Serve as Chief Retention Officer to implement strategies to both recruit and retain staff
+ Counsel employees and ensures adherence to health center policy and practice
+ Conduct regular evaluations of performance on a timely basis
+ Respond to customer (patient and physician) concerns in a responsive, timely, and respectful manner. Thoroughly reviews system to make changes where appropriate to improve the process and avoid repetition of issues
+ Participate in the identification, study of feasibility, and development of the services line through strategic plans/policies, in collaboration with CMO, Administrative Director, Safety and medical/program directors. Implement strategies that contribute to and support the organizations direction
+ Design, facilitate and/or implement quality improvement projects to improve patient care process/systems for division of responsibility. Incorporates results of customer and staff surveys into quality improvement projects
+ Write business plans as needed, including development of financial pro forms in collaboration with the Finance Department
+ Negotiate contracts with payers, physicians, and service line vendors, in concert with CMO and the Finance Department
+ Ensure that adequate human resources are provided, retained and utilized in an efficient manner to maintain objectives of the organization. Promotes excellence and professional growth of staff through mentoring and staff development
+ Facilitate teamwork and effective flow of ideas by engendering an environment of trust characterized by openness, honesty, and fairness. Promote team ownership of projects, goals, and department responsibilities
+ Promote and develop strategic relationships with physicians, facilitate good working relationships between physicians and staff, and maintains a high level of professionalism and good humor in working with physicians
+ Facilitate effective communication between and among patients, family, staff, physicians and other departments or divisions within the Health Center, as well as with the Executive Team
+ Prepare and present oral and written reports including graphic and visual
+ Comply with Health Center and division standards, including but not limited to safety, infection control, performance improvement, confidentiality, staff education and competencies
+ Ensure divisions compliance with all personnel, organizational, accrediting and licensure standards, and with state and federal laws
+ Position Specific:
+ Create, gain approval for, implement and monitor a model for integrated coordination function, involving registered nurse, and social work case managers and other relevant professionals that measurably improve performance
+ Create, and analyze utilization review metrics, maintained in the form of a dashboard, ensuring appropriate length of stay and cost per case
+ Ensure daily patient Interqual assessment and appropriate level of care positioning through out the hospital experience
+ Complete ongoing educational needs assessment, identifying areas for improvement, in addition to providing education on continual changes in Medicare regulation and reimbursement
+ Form positive relationships with surrounding healthcare providers, establishing improved continuity of care and smooth transition across the continuum. Consider opportunities for formal contracted relationships with local nursing homes and long term acute care facilities
+ Facilitate Resource Management Committee, including collaboration with physicians, and suggesting methods for provision of efficient, quality care
+ Collaborate with Financial Admitting case manager and other departments as needed to ensure that all medical necessity review processes are performed and are complete, accurate and timely
+ Provide oversight and secondary review when required for admissions and prevents inappropriate admissions (evaluating medical necessity and inappropriate level of care) by collaborating with Financial Admitting case manager, Admitting, Emergency Dept, and Admitting physicians to ensure appropriate utilization of resources. Attends daily Bed Rounds meeting and communicates with Administration and other Directors to ensure appropriate utilization
+ Refer appropriate cases to the Physician Advisor where there are concerns or questions regarding treatment, utilization patterns, etc. Gathers and analyzes utilization data, and collaborates with other health care professionals and departments including Risk Management & Quality Management. Identifies trended problems and educates staff concerning pertinent issues
+ Responsible for final review of all Medicare 1 Day Stays, i.e., verification of clinical review and for presenting monthly report on Medicare 1 day stay to appropriate committees
+ Provide oversight for Monitoring and tracking of all Outpatients to Inpatients, i.e., all outpatients that need to be converted to inpatients and are approved by financial case manager or Supervisor
+ Lead performance improvement activities for case management. Create strategies to positively impact the attainment of targeted goals and outcomes
**Required qualifications for this position include:**
+ Graduate of a recognized registered nurse program
+ RN with current license in the State of California
+ 5 years direct patient care experience
+ 3 years supervisory experience
+ Recent clinical experience in case management, hospital operations, accreditation standards, healthcare regulations, and policy formation
+ Effective organizational, oral and written communication skills, problem solving, program development, strong leadership, and team building skills
+ Ability to work with a variety of disciplines and all levels of staff across the health system
+ Computer literacy, i.e., basic Microsoft computer applications with Outlook, Word, Excel, PowerPoint, skills required, and ability to type 35 wpm
+ Advanced knowledge of case management, hospital operations, accreditation standards, healthcare regulations, and policy formation
**Preferred qualifications for this position:**
+ Master's degree in Nursing or other related field
+ Expertise in application of InterQual criteria and Case Management software, e.g., McKesson InterQual
**About the hospital you will serve.**
Providence Saint Johns Health Center in Santa Monica, California, is part of Providence Health & Services, an integrated, not-for-profit network of hospitals, care centers, medical clinics, home health services, affiliated services and educational facilities in the western United States. Founded in 1942, Providence Saint Johns Health Center enjoys a reputation for clinical excellence across many disciplines. The 266-bed health center has a medical staff of more than 900 physicians, 1,800 employees and a host of volunteers who share a commitment to providing quality care for all.
**We offer a full comprehensive range of benefits - see our website for details**
**Our Mission**
As expressions of Gods healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
**About Us**
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
**Schedule:** Full-time
**Shift:** Day
**Job Category:** Nurse Director/Executive
**Location:** California-Santa Monica
**Req ID:** 244324
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