Directs the care coordination program for the Hospital Division, providing leadership to district and facility case management teams, division, district and facility leadership and physicians. Partners with the Operations and Clinical Operations Leadership team, to assure that the care is coordinated to improve the outcomes, coordination and efficiency of care delivered to patients.

Ensures that case management services comply with the Conditions of Participation, standard treatment protocols and lengths of stay for diagnosis-related groupings ("DRG") within Kindreds long term acute care hospitals. Assures that the case management program provides for and ensures that appropriate and cost effective medical, medically-related social services and behavioral health services are identified, planned, obtained and monitored for individuals eligible for long term acute care health services. Leads, directs and manages a complex and diverse national work group to ensure care is coordinated between clinical teams and payers.

Essential Functions:

• Leads the division's strategic, operational, service design and other organizational plans and policies to achieve its mission and vision.

• Oversees the development, communication and implementation of policies and procedures for care management that guide and support the provision and integration of services according to its mission and vision

• Responsible for achieving budget, revenue, capital and operational expense, and staffing goals

• Partners with multiple stakeholders to establish short and long-term strategic planning goals for care coordination program. Ensures that reporting and analytics related to case management are utilized and available for optimal case management function

• Oversees the design, implementation and monitoring process to ensure appropriate authorizations or determinations of medical necessity for all payor sources and facilitates collaboration with divisional, district, hospital, and managed care leadership groups, with the goal of decreasing payor denials or non-medically necessary days at the facility level.

• Serves as consultative resource for facilities regarding complex discharge management.

• Keeps Senior Management abreast of care coordintion plans, programs, and progress.

• Provides for orientation, in-service training, continuing education, annual performance and competency reviews of case management teams to ensure staff is competent to provide services.

• Ensures that standards of case management practice and integrated services are developed that are consistent with professional standards, regulatory requirements and assures programs are compliant with corporate compliance agreement.

• Assesses learning needs related to case management practice and implements appropriate educational activities to expand knowledge base. Ensures that training modules meet specified learning needs.

• Researches and recommends appropriate care coordination model that meets the needs of hospitals, local care management teams including established care plans by DRG.

• Recommends and determines the sufficient number of staff to provide services and defines qualifications, performance expectations and competence of each person.

  Education:  

• Nursing degree with a Bachelor's degree in a healthcare or related field required.
• Master's degree in healthcare administration, business, informatics, or related field preferred.

  Licenses/Certification:  
   

•  Case Management Certification desirable 

  Experience:  
   

•  Required minimum of 5 years' experience in case management/utilization management; including minimum of five years' experience at case management managerial level. Prefer experience in multi-facility healthcare system. 

  Experience in Managed Care relations preferred.