Under limited supervision, the Director, Care Management is accountable and responsible for the 24/7 management, leadership, coordination, productivity, and operation of system-wide care management services including, but not limited to Care Management, Social Work, Discharge Planning, Denials and Appeals Management, Utilization Review, Quality and Peer Review. The Director is responsible for the active involvement of multiple disciplines and professional staff to reach departmental and organization-wide clinical, financial, and quality targets of performance. The Director acts as a liaison and an advisor for community resources and agencies to support the department's ongoing success. The Director appropriately manages people, relationships, and processes among internal and external customers to achieve maximum UM Capital Region Health (UM Capital).

Principal Duties:

1. Provides direction and leadership in the oversight and management for Care Management, Social Work, Discharge Planning, Utilization Review, Quality and Peer Review. 2. Confers and consults with federal and state agencies on matters related to Care Management.

3. Serves as an organizational expert regarding local, state, federal, Medicare, and other applicable regulatory bodies/regulations.

4. Initiate and coordinates control systems to identify effort and assure an accurate and efficient care management system.

5. Fosters relationships with system and community-wide post-acute care facilities.

6. Plans and implements formal education sessions for Care Management and UM Capital as an entirety regarding policies, procedures, regulations, and mandates of federal and state agencies and Utilization and Quality Improvement Committee requirements.

7. Projects a health leadership style that is participatory.

8. Maintains membership in professional networks and attends learning activities (i.e., conferences, webinars, specialty organization meetings, etc.) to maintain expert-level knowledge in care management.

9. Leads, directs, and/or educates physicians, their offices, and clinics in care management and outcomes management.

10. Submits and presents frequent updates to the Chief Nursing Officer (s) and other disciplines and leadership structures to include Shared Governance on issues that affect UM Capital Care Management structures, processes and outcomes.

11. Is a resource and works collaboratively across the UM Capital system and with interdisciplinary groups in support of achieving high quality patient care outcomes, coordination of care, and fiscal outcomes.

12. Partners with the physician advisor(s) to create dyad leadership to meet clinical, continuum, and fiscal outcomes in alignment with the nursing and organizational strategic plan.

13. Participates in continuous quality improvement initiatives including ensuring the referral of appropriate cases to the Quality Improvement Department. Monitors variance from existing clinical pathways and/or protocols.

14. Identifies and participates in initiatives to address system issues that may negatively impact lengths of stay, quality of care and/or inappropriate use of resources.

15. Directs studies of problem areas to improve utilization of health care services.

16. Facilitates the growth and ongoing development of the Care Management program based on leading industry practices, and benchmarking for leading clinical practices.

17. Responsible for the development, monitoring, analysis and trending of statistical and narrative data to analyze clinical, financial and quality indicators and outcomes.

18. Coordinates with multidisciplinary and performance improvement teams to collaborate on process improvement and implement service and system enhancements in a timely manner and in accordance with the hospital's mission and departmental goals and objectives.

19. Does related work as assigned.