Job Description

General Summary

Manages the Hospital Care Management Departments and their associated services for all WellSpan entities. Works closely with caregivers and staff in WellSpan's Finance Department to ensure the coordination and efficiency of care while meeting the contractual requirements of payor contracts. Assists with the redesign of care to ensure success with new models of payment that place WellSpan at risk for the cost and quality of healthcare services.

Duties and Responsibilities

• Designs and develops case management programs, products, policies and procedures.
• Identifies patient needs and develops case management programs to meet those needs across the system.
• Coordinates the system’s care management and utilization management activities with those of other hospitals, community agencies, payers, and other parties related to our patients and their families.
• Performs case audits and/or chart reviews.
• Develops programs in collaboration with WellSpan entities and service lines that help ensure the successful management of payor contracts that place WellSpan at risk for the financial and clinical outcomes of patient populations. Develops and manages department budgets and ensures departments operate within budget.
• Provides leadership of the Regional Care Management Directors and Utilization Management Director.
• Recommends staffing levels, selects and assigns staff, evaluates performance, evaluates/tests competencies (as applicable), provides orientation, training and continuing education of staff, and initiates or makes recommendations for personnel actions.
• Coordinates and integrates services within the department/service line/entity, with other departments/service lines/entities, and with the system's primary functions. Participates in the selection of outside services (if needed).
• Compiles data for and prepares regularly scheduled or special reports, analyses and statements.
• Develops, establishes and implements goals, objectives, and policies and procedures for department/service line/entity operation, and which guide and support the provision of the department/service line/entity's services.
• Recommends sufficient space and other resources required by the department/service line/entity.
• Oversees the provision of, and provides therapeutic intervention with patient and family including individual, marital, parental, family and group therapies.

Common Expectations:

• Demonstrates knowledge of the principles of growth and development over the life span of the assigned patient population. Assesses and interprets patient age specific data and provides appropriate, age specific treatment.
• Demonstrates a commitment to patient, visitor and staff by: complying with all applicable safety regulations; learning the impact of medical errors and methodology that will lead to reduction of errors; reporting actual and potential errors, as well as hazardous conditions; identifying opportunities to standardize processes and "error proof" systems that will lead to increased safety; and participating in safety education programs and root cause analyses as required. Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

Qualifications

Minimum Education:

• Masters Degree Required

Work Experience:

• At least 5 years relevant care management experience required.
• At least 5 years of progressive leadership experience required.

Licenses:

• Licensed Registered Nurse Upon Hire Required or
• Registered Nurse Multi State License Upon Hire Required or
• Licensed Social Worker Upon Hire Required