Director, Case Management
Allegheny Health Network is an integrated delivery network focused on preserving health care choice and providing affordable, high-quality care to the people in our communities. With more than 14,000 employees including 7,400 health care professionals, nearly 200 primary care and specialty care practices, Allegheny Health Network includes seven hospitals in Pennsylvania with nearly 2,400 licensed beds.
Allegheny Health Network’s clinical expertise ranges from primary care to the most complex surgical procedures. Services include cancer diagnosis and treatment, cardiovascular care, neurological and neurosurgical services, organ transplantation, orthopedic and rehabilitation services, and women’s health.
JOB DUTIES:
Responsible for coordinating the development, implementation, administration, evaluation and transformation of hospital based care management, social work, discharge planning, and utilization management program. Demonstrates the ability to design and deliver a regulatory compliant, outcome based care management program and integrates quality and care management activities into a core business process for Jefferson Hospital.
Accountable for achieving JH’s utilization management goals, as well as supporting the Clinical Resource Utilization Management Committee. Monitors and directs performance improvement efforts towards measurable improvement of clinical, financial and case mix goals as outlined in the business plans of all departments/services and Jefferson Hospital.
Provides leadership, coordination and oversight of all care management activities, including implementation of appropriate patient care plans, utilizes knowledge and skills to help resolve complex issues and serves as a resource for all team members, Hospital employees and physicians.
Provides planning strategies for care management that includes integration and education for a seamless care system and for the timely transformation of patients throughout the acute care episode. Involves ancillary departments and system support services to achieve a positive and desired outcome.
Responsible to educate the medical staff, community providers and system employees of appropriate, efficient and timely utilization of health care resources. Builds positive working relationships and services as liaison.
Responsible for integrating the Hospital’s patient safety, service excellence and clinical quality improvement activities into case management. This may include patient/physician-related issues, performance improvement, medical staff peer review, case management, social work, outcome staffing, continuing education, competencies, hiring, disciplinary procedures.
Responsible for the supervision and coordination of the Community Care Network, ensuring quality care through the utilization of program goals and supported outcomes.
Works collaboratively in the AHN matrix reporting environment.
Oversee the high risk readmission process
QUALIFICATIONS:
Bachelor's Degree in Nursing required. Master's degree must be obtained within 5 years.
Minimum of 3 years experience in a management role. Minimum of 5 years care management experience required. Excellent presentation skills and demonstrated leadership skills required.
Current PA RN license required.
National recognized Care Management certification within five years of start date (3 years for currently employed CC's) required.
CPR Certification required