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Director Care Management- Nursing Administration

Company: Nicklaus Children's Hospital
Location: Miami
Posted on: January 16, 2022

Job Description:

Job Summary
Responsible for directing all activities within a department, developing and maintaining quality-improvement programs, collaborating with physicians and medical staff to ensure service expectations are being met and directing the workflow of Case Managers. Serves as a resource for the case management team and other departments.
Job Specific Duties

  • Responsible and accountable for all operations within areas of oversight.

  • Continually seeks, analyzes, and enhances the quality of patient care and services to ensure high quality integrated care. Ensures care delivery processes are at the cutting edge of clinical quality and safety. Supports safety culture initiatives and ensures high level of compliance with regulatory standards, CMS, and public-reporting indicators of clinical practice.

  • Ensures case management process is initiated effectively across the organization, and patients receive the appropriate level of care across the continuum.

  • Maximize benefits by coordination of cost effective care, avoid fragmented care, and duplication of services. Ensure the appropriate level of care is provided in the most suitable setting.

  • Perform random charting review to ensure accurate and thorough documentation to support reimbursement of services rendered.

  • Data analysis related to Case Management metrics; develops, implements, and monitors action plans related to denials, avoidable days, LOS, and other identified case management metrics.

  • Anticipates and proposes opportunities to improve current technology or identify new technology to enhance performance and productivity. Leads initiatives in assigned facilities.

  • Assesses learning needs related to case management practice and implements appropriate educational activities to expand knowledge base.

  • Leads and directs process improvement initiatives and other safety programs; ensures applications and concepts are standardized and reliable processes and sustained in the department. Supports process improvement and incorporates science principles into quality/process improvement activities while working with leadership ensuring application of evidenced based practice in the departments.

  • Collaborates with nursing, medical staff, various administrative staff, and leaders in planning for and providing quality and consistent patient care services based on best practice and ensuring patient and family centered principles and decision-making. Facilitates communication and cooperation across departments to ensure the standardization and continuum of care.

  • Accountable for patient satisfaction and employee engagement scores. Supports patient/family experience, initiatives, and leading practices. Promote and maintain positive relations with patients and their families, as well as, other healthcare organizations. Rounds in departments with medical and business leaders to solicit input from staff, families, and patients; collects data, supports improvements and tracks results. Ensures updates on opportunities and outcomes are shared with clinical staff during meetings or huddles. Recognizes staff members who are identified by families and helps embed a culture of service excellence with all staff. Guides establishment of standards, provides training, and enforces compliance with departmental customer service and employee engagement programs and initiatives.

  • Remains current with state and federal associations, professional trends, and by participating in community activities. Actively involved in a professional organization. Shares best practices with nursing leadership. Develops reviews and revises departmental policies and procedures and assures the department's compliance with DNV, state, and federal regulations, as well as, current evidence-based guidelines.

  • Ensures highest integrity for the business operations of the departments. Strategically positions the departments to react effectively to unplanned circumstances, demands, and challenges facing the industry while creating revenue enhancements and cost reduction practices. Ensure sufficient staffing to meet patient care needs while monitoring and ensuring compliance with department budgets.

  • Oversees and supports talent development of the leadership team to ensure succession planning, mentorship, and coaching within departments leading to strategic goal accomplishment. Provides ongoing performance feedback, coaching, and mentoring to leaders and staff. Builds a high performance environment by fostering staff empowerment, holding team members accountable, utilizes the department engagement champions to increase staff communication, recognition, and talent retention.

    Minimum Job Requirements

    • Bachelor's Degree in Nursing (BSN), Healthcare, Finance, Business Administration, or related field

    • Registered Nurse Licensure in the State of Florida or Multi-State Enhanced Nursing License Compact (eNLC) - maintain active and in good standing throughout employment

    • 3-5 years of managerial and leadership experience in an acute care environment with oversight of clinical departments and teams

    • Prior experience in leading and implementing large scale projects, system implementation, and organizational change
      Knowledge, Skills, and Abilities

      • Master's Degree - MSN, MHA, or MBA preferred.

      • NE-BC or NEA-BC and/or CCM preferred.

      • InterQual criteria and Midas Information systems preferred.

      • ICD9, CPT, HCPCS APC, DRG, Revenue Codes and Status indicators related to ambulatory and outpatient reimbursement.

      • Able to establish strong external business relationships with vendors and other recognized industry leaders.

      • Ability to work independently and interact with personnel from entry level to executive management.

      • Strong problem solving skills, detail oriented, knowledge of performance improvement, and change management concepts & tools.

      • Knowledge of managed care, government payers, and third party reimbursement payer requirements.

      • Strategic planning and project management skills.

      • Ability to work in a team, build consensus, influence others outside a direct reporting relationship, and handle conflicts with tact.

      • Understanding of coding, CDM, charge capture, and billing processes, general knowledge of healthcare revenue cycle, and familiarity with reimbursement.

      • Prior experience with auditing and internal controls review in a healthcare revenue cycle.

      • Understanding of compliance issues and their importance and consequences.

      • Strong analytical and advanced computing skills. MS Office, spreadsheets, relational databases, and internet searches to complete research experience.

      • Prior experience with various technologies, hospital information systems, and other tools used in patient financial services, particularly Cerner.

      • Strong organizational skills including priority setting, planning, and effective decision making.

      • Excellent communication and negotiation skills.

      • Motivated and self- directed with a high degree of professional accountability.

      • Ability to make a significant contribution to the organization's overall effectiveness.

        Job :Nursing - Management
        Primary Location :Florida-Miami-Nicklaus Children's Hospital - Main Hospital Campus
        Department :NURSING ADMINISTRATION-2100-860950
        Job Status
        :Full Time

Keywords: Nicklaus Children's Hospital, Miami , Director Care Management- Nursing Administration, Executive , Miami, Florida

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