Directs, plans, implements and evaluates all activities of the inpatient RN Case Management and Social Work Services team. Develops processes to monitor utilization review inclusive of length of stay (LOS) and resource reduction strategies, excess days throughput and industry benchmarks. Capitalizes on facility best practices and makes recommendations for process improvement. Oversees resource utilization for the hospital and provides specific data analysis on utilization to the committee to drive performance. Acts as a liaison to regulatory agencies to ensure compliance of requirements and to ensure third party payers reimbursement/ coverage is approved to meet patients’ level of care. Oversees the coordination of care and transitions of care processes and outcomes across the continuum and provides data and analytics to drive performance improvement in this area. Additionally oversees discharge planning for complex patients identifying social barriers and linkage to services supporting care transitions and safe discharge back to the community.

Responsibilities: 

• Leads RN case management and social work services team by developing, communicating, and building consensus for goals/programs that support business unit
• Directs, plans, implements and evaluates care coordination of patient care across the continuum of care; collaborates with other hospital directors, establishes goals and objectives for the department
• Develops and articulates a short-term (6 months – 1 year) strategic vision for areas of responsibility
• Develops strategies and programs to achieve goals, as evidenced by positive quality clinical and administrative outcomes
• Performs strategic planning and programmatic development for the care coordination department
• Collaborates with physician leadership to develop strategies, formulate plans and implement interventions based on patient needs and clinical resources
• Analyzes and evaluates effectiveness of patient care standards, policies and procedures to improve quality of patient care and plans utilization of staff resources and activities aimed at continued quality care
• Interprets and implements administrative policies and operational procedures
• Develops and implements policies and procedures supporting quality patient driven care through efficient and effective care coordination
• Screens and investigates incidents and patient complaints; determines follow-up needed and initiates corrective action
• Guides, mentors, motivates and engages the staff in assessing, planning, implementing programs and evaluating patient care as evidenced by patient satisfaction and positive clinical outcomes
• Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions

Qualifications:

• Master’s Degree in Nursing or related field required, or equivalent combination of education and related experience. Bachelors or Masters must be in Nursing.
• Current license to practice as a Registered Professional Nurse in New York State, required, plus specialized certifications as needed
• 8-12 years of relevant experience, and 7+ years of leadership/management experience, required