Director Care Management- Nursing Administration
Company: Nicklaus Children's Hospital
Posted on: January 16, 2022
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
Job Specific Duties
Responsible and accountable for all operations within areas of
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
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
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
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
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
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
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
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 &
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
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
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,
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
Ability to make a significant contribution to the organization's
Job :Nursing - Management
Primary Location :Florida-Miami-Nicklaus Children's Hospital - Main
Department :NURSING ADMINISTRATION-2100-860950
Keywords: Nicklaus Children's Hospital, Miami , Director Care Management- Nursing Administration, Executive , Miami, Florida
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