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The Director of Care Management oversees the Care Management program and coordinates and integrates patient care outcomes, resource utilization and treatment patterns, discharge planning, social services, psychosocial assessment, and therapeutic interventions.  The Director assists in developing and implementing policies and procedures, monitors Care Management reports and assists in the development of alternative care methods. Incorporates differences into the provision of care.  Relies on extensive experience and judgment to accomplish responsibilities.  A wide degree of creativity and latitude is expected and leads and directs the work of others.

Experience, Education, Training, Special Skills, and Licensure:

• Three or more years of recent acute care experience. Five years demonstrated management in a fast paced, complex environment.
• Bachelor's degree RN or Social Work
• Knowledge of fiscal management department operations, managed care concepts and strategies and DRG reimbursement system. Is able to convert DRG and Physician Practice pattern data into information which quantifies impact on cost and quality. Demonstrates the ability to implement new programs and problem-solving mechanisms. Knowledge of Medicare/Medicaid and Third Party admission and concurrent review criteria.

Must have a current license to practice Nursing or Social Work in the State of Louisiana.

Job Function:

1. People
   1. All new team members are selected using the approved team-staffed, behavioral-based interviewing process, attend general orientation, and are provided departmental orientation, culture assimilation assistance/onboarding, and initial competency checklist timely.
   2. A comprehensive team member communication and engagement plan is developed and followed, incorporating at minimum rounding on all shifts, monthly staff meetings, staff involvement in planning and quality improvement activities, recognition events, performance and career coaching, and cascade learning from hospital leadership meetings, and bulletin boards.
   3. Team Culture effectiveness is assessed at least annually and compared to high performance benchmarks, action plans are developed, PDCA follow-through is documented, and measurable improvement is achieved.
   4. Disruptive behavior that can degrade a culture of respect and safety are identified, reported, and effective corrective action is taken timely.
   5. Quality training and orientation is provided to all assigned employees, co-workers are informed of relevant departmental policies and procedures, and departmental work schedules and duty assignments are monitored on a daily basis.
   6. Guidance and support to staff members is provided, assisting in aiding the removal of performance barriers.
   7. Departmental performance is reviewed, performance deficits are identified, and recommendations that promote departmental efficiency are implemented. This is exhibited by daily monitoring and reporting of "Avoidable Days" on each unit.
2. Service
   1. Team member satisfaction scores for areas of responsibility minimally achieve 75th percentile, ideally 90th percentile.
   2. Minute surveys for areas of responsibility reflect consistent pattern of physician satisfaction, with any concerns followed up on timely.
   3. Standards of Performance for all required forms of rounding are consistently met.
3. Quality/Safety
   1. Core measure goals/quality indicators are consistently achieved in areas of responsibility.
   2. Performance data elements of concern, incidents/sentinel events, new regulatory requirements, new technology, medical advances, low volume/high risk procedures, etc. are systematically reviewed, staff competency training is regularly planned and delivered to 100% of staff (ideally in actual patient situations) considering the special attributes of patient populations served (if applicable), and the impact of the training is tracked.
   3. Regulatory agency surveys and mock surveys reveal no deficiencies to their standards.
   4. Patient education outcome statistics are maintained, and performance meets national benchmarks when available.
   5. Coordinates and integrates quality review activities pertaining to clinical coordination, resource utilization, system management, analysis and evaluation in an effort to enhance operating efficiency. Advises hospital personnel on the Care Management processes in an effort to enhance employee job performance.
   6. 100% of all privacy referrals are documented, tracked, investigated and action taken on all complaints concerning facility's privacy policies and procedure in cooperation with other departments and when necessary, legal counsel.
   7. Initial and on-going privacy training is provided to 100% of staff.
4. Stewardship
   1. Annual goals, objectives, and action plans reflect and actualize FMOLHS and facility's strategic and annual plans, initiatives and challenges.
   2. Annual budget and budget performance achieve facility's staffing and supply utilization/inventory benchmarks/standards.
   3. All contributions of areas of responsibility to patient throughput are identified, quantified, and benchmarked, with action plans to optimize developed, approved, implemented, and made subject to regular PDCA review.
   4. Department operational and/or clinical policies and procedures for areas of responsibility are reviewed annually and updated as needed.
   5. The Medicare LOS is consistently below 5.
   6. The development and recommendation of the annual department operating and capital budgets has occurred. Monitors the economical use and procurement of personnel, equipment and supplies on a monthly basis.
   7. Data is analyzed, variance reports prepared, and departmental/organizational records monitored to ensure appropriate resource management and the provision of high-quality health care services by each department.
5. Growth
   1. Market share for revenue services is monitored, environmental assessments and critical factor analyses are conducted, and plans for market share growth are developed, approved, implemented, and made subject to regular PDCA process review.
   2. Opportunities for facility to enhance community health, wellbeing, security, wealth and/or productivity within the precepts and resources of its ministry are sought through a significant personal commitment of this incumbent to reaching out and engaging in health-related community events, service organizations, etc. When practical opportunities are identified, incumbent follows through with discussions, proposals/business plans, etc., to assure that opportunity is given due consideration.
6. Other Duties as Assigned
   1. Consistently performs 12 organizational Service Standards focused on Values, Service and Quality.
   2. Actively participates in performance improvement committees or projects as needed.

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