Case Managment /Care Coordination Director - Nuvance Health

Description

Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care.  Non-acute care is offered through various affiliates,

Registered Nurse or Masters Social Work with management experience

$30K SIGN ON BONUS - FOR ELIGIBLE EXTERNAL CANDIDATES

Summary:
Ensure that patients receive quality care in the most cost-effective manner and at the appropriate level of care. Manage the operations and activities of the Care Coordination Department including discharge planning, utilization management and high-risk case management. Works collaboratively with the Director of transitions to ensure optimum utilization of Social Work Skills. Responsible for achieving and promoting continuous quality improvement, optimal financial productivity, patient satisfaction and other objectives identified by the Leadership Team. In collaborating with the Executive Director, this position is responsible for staff performance, establishing policies and procedures governing operations of the program and accomplishment of goals in accordance with all State and Federal Guidelines.

Responsibilities:
1. Provides direct management to Care Coordination Staff.  Develops program philosophy and operational goals consistent with the Organization’s Mission and Strategic Plan. Ensures program compliance with Joint Commission, State and Federal Regulations relative to Discharge Planning, Utilization Management and Continuum of Care. Creates and fosters positive customer relationships with patients, physicians, healthcare agencies and the Network. Supports effective Customer Service Networks in collaboration with the Director of Transition. Identifies opportunities for growth. Develops and implements new services and/or programs. Interfaces and coordinates services with Admission, Finance, Managed Care, Medical Records, Home Care, Rehabilitative and Risk Management. Ensures provisions of a seamless continuum of care. 

2.  Establishes and coordinates communication with all Utilization Regulatory Agencies i.e. Qualidigm, NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials. Oversees appeals, at the first level of appeal as appropriate, in an effort to maximize reimbursement. Reviews and edits Managed Care Contract Language relating to Utilization Management Issues. Ensures severity of illness and intensity of service criteria evaluations are completed on all patients to achieve efficiency, ensure cost-effective utilization of Hospital Resources and optimize financial performance. Collaborates with UM Medical Director and Vice President of Medicine. Develops and monitors Department Budget to achieve efficiency, cost containment and optimal financial performance and productivity Fulfills all compliance responsibilities related to the position

3. Performs other duties as assigned

Other information:
Required: Bachelor Degree in Nursing and minimum of five years job-related experience. Master's degree in nursing or health management desired but not required.  MSW considered
Minimum Experience: five years

Desired: Registered Nurse with management experience . Knowledge of community resources, agencies, financial assistance programs/knowledge and/or experience in managed care plans. Excellent communications skills. Ability to collaborate with multidisciplinary groups and staff at all levels including community partners. Problem solving achieves specified goals and assists staff to critically think to reach optimum outcomes. Fosters teamwork and has the ability to integrate the Care Coordination Model and be a change agent. Must possess comprehensive knowledge of the healthcare Industry, familiarity with government regulations and possession of strategic planning skills.

Location: Norwalk-34 Maple St

Work Type: Full-Time

Standard Hours: 40.00

FTE: 1.000000

Work Schedule: Day 8

Work Shift: 8a-4:30pm

Org Unit: 374

Department: Care Coordination-NH

Exempt: Yes

Grade: L2

Salary Range: 

$49.7556 - $92.4018 Hourly

Education:
Essential:
* Bachelor's Level Degree

EOE, including disability/vets.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.