Director, Care Management Ops-South Chicagoland PSA Job at Advocate Aurora Health
Major Responsibilities:
Strategy & Integration – Accountable for contributing to development of the enterprise strategic and annual operating plans for IL or WI for Advocate Aurora care coordination inpatient and ED care management programs in alignment with enterprise population health. Integrates national best practices and benchmarks into the program to ensure optimal outcomes for the healthcare system. Ensures the care management inpatient program goals are aligned with the overall AdvocateAurora strategic initiatives in enterprise population health. Responsible for developing a professional, team-oriented, service culture that contributes to the goals of the enterprise and department. Has expert knowledge of the processes related to financials in the revenue cycle model; supports and directs initiatives that result in improved quality, efficiency and financial performance.
Performance Management - Provides accountability and oversight for the development of structures, processes and initiatives designed to improve care coordination projects that will define the continuum of care for each patient population and best practice solutions for care coordination. Ensures a plan for education, communication, training and implementation planning. Serves as a leader for oversight for the AAH site CM leaders to ensure delivery of the vision, strategies, and roadmap including utilization outcomes, process metrics, and financial performance of all value based contracts (significant impact on the AAH financial performance). Provides leadership/mentorship to site leaders of CM for effective implementation and optimal performance. Leads in setting performance management goals, operating plans, dashboards, and outcome tracking tools to ensure performance is monitored, on target and achieving intended outcomes. Rounds on site CM leaders at AAH sites including observations and onsite reviews/rounds to ensure project deployment and operation are in alignment with system goals/targets. Works with performance improvement and project managers as project leads related to care coordination tactics as assigned (Medicare Bundled Payments for Care Initiatives and Medicare Shared Savings Program).
Communication / Relationships – Accountable for communication and data reporting to Site Leadership Teams and key stakeholders. Provides leadership and mentorship to site managers and supervisors to ensure effective implementation, change management, and optimal performance. Collaborates with Executive Director in setting KRAs, operating plans, dashboards, and outcome tracking tools to ensure performance is monitored, on target and achieving intended outcomes.
Budgeting – Accountable for site operating / capital budgets for IL / WI.
Regulatory & Compliance – Ensures that the site care management programs for the assigned region operate under compliant CMS, federal and state practice standards and codes of ethics.
Technology – Ensures appropriate care management tools and software are operational and support the needs of the strategic plan and initiatives for Integrated Care Management for AAH.
Utilization Management - Site oversight for the utilization management operations for AAH as assigned that are part of the comprehensive care management program that supports reimbursement and revenue enhancement. Works collaboratively with payers, providers to ensure a standardized, efficient, and highly effective process for UM. Identifies opportunities related to appeals of medical necessity denials and quality inquires. Demonstrates expertise in utilization management and clinical reimbursement that demonstrates a working knowledge of current admission, continued stay, and discharge appropriateness criteria.
Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business.
Licensure, Registration, and/or Certification Required:
Registered Nurse license issued by the state in which the team member practices.
Accredited Case Manager (ACM) certification issued by the American Case Management Association (ACMA) needs to be obtained within 1 year, or
Care Manager Certified (CMC) certification issued by the National Academy of Certified Care Managers (NACCM) needs to be obtained within 1 year, or
Nursing Case Management (RN-BC) certification issued by the American Nurses Credentialing Center (ANCC) needs to be obtained within 1 year.
Education Required:
Master's Degree in Nursing, or Bachelor's Degree in Nursing, and Master's Degree in Health Care Administration or related field.
Experience Required:
Typically requires 7 years of clinical experience.
Minimum of 3 years of care management leadership experience in a clinical setting.
Knowledge, Skills & Abilities Required:
Strong analytical ability to gather, interpret, and utilize data in decision-making
Demonstrated self-direction and results orientation
Expertise in operations improvement and quality management
Demonstrated excellence in organizational and project management skill
Critical thinking skills
Demonstrated political sensitivity to the dynamic interplay that occurs between hospital sites
Demonstrated success facilitating teams on complex projects
Strong leadership skills
Ability to work in an unstructured, developing environment
Experience in an integrated health care delivery model across a continuum of services such as care management models
Understanding of analytics and performance metrics that drive behavior
Experience working with contracts where financial performance is at risk for a health care delivery system
Strong operational skills including strategic planning, operational work plans with demonstrated adherence to timelines
Ability to lead a team and work with a diverse team of stakeholders
Excellent presentation skills with experience communicating with high level executives internally and externally with outside stakeholders.
Please Note :
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Strategy & Integration – Accountable for contributing to development of the enterprise strategic and annual operating plans for IL or WI for Advocate Aurora care coordination inpatient and ED care management programs in alignment with enterprise population health. Integrates national best practices and benchmarks into the program to ensure optimal outcomes for the healthcare system. Ensures the care management inpatient program goals are aligned with the overall AdvocateAurora strategic initiatives in enterprise population health. Responsible for developing a professional, team-oriented, service culture that contributes to the goals of the enterprise and department. Has expert knowledge of the processes related to financials in the revenue cycle model; supports and directs initiatives that result in improved quality, efficiency and financial performance.
Performance Management - Provides accountability and oversight for the development of structures, processes and initiatives designed to improve care coordination projects that will define the continuum of care for each patient population and best practice solutions for care coordination. Ensures a plan for education, communication, training and implementation planning. Serves as a leader for oversight for the AAH site CM leaders to ensure delivery of the vision, strategies, and roadmap including utilization outcomes, process metrics, and financial performance of all value based contracts (significant impact on the AAH financial performance). Provides leadership/mentorship to site leaders of CM for effective implementation and optimal performance. Leads in setting performance management goals, operating plans, dashboards, and outcome tracking tools to ensure performance is monitored, on target and achieving intended outcomes. Rounds on site CM leaders at AAH sites including observations and onsite reviews/rounds to ensure project deployment and operation are in alignment with system goals/targets. Works with performance improvement and project managers as project leads related to care coordination tactics as assigned (Medicare Bundled Payments for Care Initiatives and Medicare Shared Savings Program).
Communication / Relationships – Accountable for communication and data reporting to Site Leadership Teams and key stakeholders. Provides leadership and mentorship to site managers and supervisors to ensure effective implementation, change management, and optimal performance. Collaborates with Executive Director in setting KRAs, operating plans, dashboards, and outcome tracking tools to ensure performance is monitored, on target and achieving intended outcomes.
Budgeting – Accountable for site operating / capital budgets for IL / WI.
Regulatory & Compliance – Ensures that the site care management programs for the assigned region operate under compliant CMS, federal and state practice standards and codes of ethics.
Technology – Ensures appropriate care management tools and software are operational and support the needs of the strategic plan and initiatives for Integrated Care Management for AAH.
Utilization Management - Site oversight for the utilization management operations for AAH as assigned that are part of the comprehensive care management program that supports reimbursement and revenue enhancement. Works collaboratively with payers, providers to ensure a standardized, efficient, and highly effective process for UM. Identifies opportunities related to appeals of medical necessity denials and quality inquires. Demonstrates expertise in utilization management and clinical reimbursement that demonstrates a working knowledge of current admission, continued stay, and discharge appropriateness criteria.
Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business.
Licensure, Registration, and/or Certification Required:
Registered Nurse license issued by the state in which the team member practices.
Accredited Case Manager (ACM) certification issued by the American Case Management Association (ACMA) needs to be obtained within 1 year, or
Care Manager Certified (CMC) certification issued by the National Academy of Certified Care Managers (NACCM) needs to be obtained within 1 year, or
Nursing Case Management (RN-BC) certification issued by the American Nurses Credentialing Center (ANCC) needs to be obtained within 1 year.
Education Required:
Master's Degree in Nursing, or Bachelor's Degree in Nursing, and Master's Degree in Health Care Administration or related field.
Experience Required:
Typically requires 7 years of clinical experience.
Minimum of 3 years of care management leadership experience in a clinical setting.
Knowledge, Skills & Abilities Required:
Strong analytical ability to gather, interpret, and utilize data in decision-making
Demonstrated self-direction and results orientation
Expertise in operations improvement and quality management
Demonstrated excellence in organizational and project management skill
Critical thinking skills
Demonstrated political sensitivity to the dynamic interplay that occurs between hospital sites
Demonstrated success facilitating teams on complex projects
Strong leadership skills
Ability to work in an unstructured, developing environment
Experience in an integrated health care delivery model across a continuum of services such as care management models
Understanding of analytics and performance metrics that drive behavior
Experience working with contracts where financial performance is at risk for a health care delivery system
Strong operational skills including strategic planning, operational work plans with demonstrated adherence to timelines
Ability to lead a team and work with a diverse team of stakeholders
Excellent presentation skills with experience communicating with high level executives internally and externally with outside stakeholders.
Please Note :
apexdining.ca is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, apexdining.ca provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.