Director, Inpatient System Care Management
Company: Alameda Health Sytem
Posted on: February 25, 2021
Director, Inpatient System Care Management SUMMARY: Alameda
Health System is seeking an experienced Director of Inpatient
System Care Management.--If you have a passion for supporting an
underserved population this may be your next opportunity! This is a
system wide positon and someone with knowledge within skilled
nursing regulations would be a plus. We have a hard working team
that is passionate about care management and the population they
serve.-- Under the direction of the Vice President of Care
Management, manages the day to day operations of the inpatient Care
Management across all AHS facilities,--including post-acute care
facility--for ensuring efficient patient flow, beginning when a
patient is admitted to the facility and ending with a safe and
clinically appropriate discharge . DUTIES & ESSENTIAL JOB
FUNCTIONS: NOTE : The following are the duties performed by
employees in this classification. However, employees may perform
other related duties at an equivalent level. Not all duties listed
are necessarily performed by each individual in the
- Accountable for Patient Care Coordination activities including
system-wide Case Management, Care Coordination and Discharge
- Aligns Case Management with AHS strategic and operational
- Optimizes efficient Care Management/care coordination roles and
processes; initiates process improvements.
- Develops, monitors and evaluates inpatient Care Management
Metrics; manages the collection, analysis and presentation data
relevant to the utilization of healthcare resources including but
not limited to avoidable/variance days, readmissions, one-day
stays, DRGs, LOS.
- Develops, maintains and implements Case Management policies,
practices and procedures in accordance with CMS, CA DCHS, the Joint
Commission, Title 22 and other regulatory agencies and overall
hospital policies; integrates managed care contract criteria into
overall Case Management functions.
- Works closely with the VP of Care Management and Physician
Advisors on any audits and secondary reviews; may include but not
limited to Direct and coordinate data gathering, chart audits and
participants in internal and external meetings.
- Oversees educational needs and plan for inpatient Care
- Recruits, trains and coaches the management staff to assist
them with performing optimally and provides appropriate
discipline/structure; consults and assists Care Management managers
with problem solving with staffing, personnel issues, budget issues
and resource management; reviews and evaluates management staff
performance, initiate personnel transactions and meet hospital
standard for performance evaluations.
- Supports the VP of CM with completion of financial analyses
including cost of care to reimbursement, denials management, and
non-reimbursed services, promoting effective resource utilization,
clinical documentation/queries quality care and patient safety;
oversees the Inpatient recovery process; works closely with Revenue
Cycle and AHS Physician Advisors; regularly communicates with
payors and/or their contracted vendors.
- Responsible for the coordination and support of the AHS
Utilization Review Committee.
- Responsible of overseeing patient, physician and staff
satisfaction based on quality outcomes and patient experience
reporting; in conjunction with the Quality Leadership, identifies
utilization issues affecting the quality of patient care.
- Provides AHS physicians, nursing and staff education including
InterQual-- criteria methodology, resource management, medical
necessity guidelines payer sources, clinical outcome metrics,
length of stay initiatives, readmission strategies, reimbursement
rules and medical record documentation requirements.
- Serves as Content Expert/Liaison to community agencies, AHS and
Non AHS primary care provider network and all AHS stakeholders
across all AHS facilities (i.e. Nursing and Hospital
Administrators) for provision of care and services across the
continuum of care.
- In conjunction with department managers and/or supervisors,
coordinates, develops, and implements action plans to respond to
areas felt to be in need of improvement related to patient flow and
care coordination across the continuum.
- Assumes accountability for improving utilization metrics
associated with department/unit and meeting
- Evaluates, plans, and executes changes in department
procedures, equipment and supplies.
- Performs all other duties as assigned. MINIMUM
QUALIFICATIONS:Required Education : Master's degree in Nursing or
Master's degree in Social Work or related field. Required
Experience: Seven to ten years of case management or quality
experience in addition to progressive management experience in a
large healthcare organization is required. Preferred Experience:
N/A Required Licenses/Certifications: Active licensure as a
Registered Nurse in the State of California or valid license as a
Clinical Social Worker issued by the State of California Board of
Behavior Science Examiners; active BLS - Basic Life Support
Certification issued by the American Heart Association; CPI -Crisis
Prevention Intervention Training; Other advanced life support
certifications may be required per unit/department specialty
according to patient care policies. Preferred
Licenses/Certifications: Certification in Case Management, CCMC or
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Keywords: Alameda Health Sytem, Oakland , Director, Inpatient System Care Management, Executive , Oakland, California
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