Director of Care Management

Company: Beaumont Health
Location: Dearborn
Posted on: March 28, 2020

Job Description:

-Director of Care Management - - - - - - - - - - - - - - - - - - - - - Facility: -Beaumont Hospital in Dearborn, MI Department: -Care Management - Full time, Days GENERAL SUMMARY: -The Director of Care Management is accountable and responsible for the departments of Care Management, Utilization Review, and Social Work. The director represents the departments on numerous corporate and hospital committees. Develops, implements, and ensures compliance with hospital and departmental objectives and develops and maintains departmental budget. The director communicates with physician/nursing staff and other ancillary staff with specific decisions regarding third-party payor criteria, the appropriate level of care and alternatives based on clinical judgment. -The Director, Care Management reports to the Chief Nursing Officer. - -ESSENTIAL DUTIES: -1. - - - - -Collaboration with Corporate Compliance, ensuring regulatory, and accreditation compliance is met related to hospital care management and the Conditions of Participation (CoP)2. - - - - -Perform high-level functions in the role of utilization review and understand its impact on revenue -and the care management department3. - - - - -Knowledge and understanding of current discharge planning functions and its impact4. - - - - -Knowledge and understanding of current payer policies, requirements, processes, and trends5. - - - - - -Demonstrates outstanding communication and interpersonal skills with success in consensus and team-building across diverse groups6. - - - - -Knowledge and understanding of NCQA certification requirements, Joint Commission accreditation standards, CMS, deferral, state, and local regulations related to hospital care management7. - - - - -Monitor and evaluate hospital care management objectives and ensure appropriate action planning to achieve measurable outcomes8. - - - - -Work closely with physician advisors, Beaumont Medical Group, community partners, and other stakeholders to ensure appropriate utilization management within the acute care setting and during transitions of careKEY LEADERSHIP COMPETENCIES: -1. - - - - -Builds Trust -2. - - - - -Creates and Communicates Clarity -3. - - - - -Works Collaboratively and Fosters Teamwork -4. - - - - -Builds a Cohesive Team -5. - - - - -Utilizes Strategic Judgment -6. - - - - -Cultivates a Service-Oriented Culture -7. - - - - -Creates and Communicates Vision and Strategy -8. - - - - -Leads Change and Innovation - - -STANDARD QUALIFICATIONS - -A. - - - -Education / Training: -Bachelor of Science in Nursing required.Master's degree in nursing or master's degree in related health care field required. -B. - - - -Work Experience: - - - - - - - - - - -Minimum of 5 years' experience in Care Management or related field. Strong leadership experience preferred. -C. - - - -Certification, Licensure, Registration: - - - - - - - - - - -Active MI RN license required. Certification in Care Management preferred. -D. - - - -Other Qualifications: -Strong Utilization Review background with payor relations, discharge planning, and excellent communication skills.

Keywords: Beaumont Health, Dearborn , Director of Care Management, Executive , Dearborn, Michigan