This position is responsible for the development and implementation of case and utilization management programs and services. This position provides leadership, direction and support for Care Coordination Services in the pursuit of best practice to achieve quality outcomes, reduce costs, and shape and interpret the standards required to ensure a high degree of patient, physician and employee satisfaction. This position will also have responsibilities for multiple facility/entity-specific patient outcomes related to patient goals, contractual deliverables, and/or connections with post-acute services.
Plans, directs and monitors the case and utilization management program(s). Provides advice, counsel, feedback and coordination to promote a collegiality between staff, physicians and the leadership team.
Ensures that development of Care Coordination services across the continuum leads to outcomes supportive of the organizations strategic plan. Designs and implements processes to ensure appropriate care coordination in accordance with regulatory and standards of safety.
Provides strategic direction for multidisciplinary process improvement activities, including the establishment of performance measures to attain optimal clinical, operational, financial and satisfaction outcomes. Directs the collection, analysis and presentation of data on utilization patterns and other program outcomes.
Oversees personnel actions including recruiting, new hire actions, interviewing and selection of new staff, salary determinations, training, and personnel evaluations. This position also participates in the development of Care Coordination goals and objectives in accordance with company standards.
Establishes and oversees the financial and capital resources for Care Coordination services by monitoring operating revenue and expenses, establishing and maintaining cost control programs and developing and implementing new or revised programs and/or services. Develops and implements strategies to work with all external customers to ensure appropriate reimbursement.
Develops and oversees the department budget(s) in conjunction with corporate goals and objectives. This position is accountable for meeting annual budgetary goals.
Assesses patient satisfaction in areas of responsibility; sets a high standard for staff and leadership to improve patient satisfaction as measured by survey scores.
BSN or MSN required for all new hires to the position after October 1, 2016. Incumbents in the position prior to October 1, 2016 must possess a bachelors degree in a related field.
Requires a current Registered Nurse (R.N.) license in state worked. Requires a Bachelors of Science in Nursing or Masters of Science in Nursing.
Must have 3 years acute experience with age specific patient population in the area of responsibility and minimally 3 years of progressive leadership experience.Must possess demonstrated flexibility in responding to the needs of multiple constituencies with a service-oriented philosophy. Must also possess demonstrated skill in problem analysis, project management, contract negotiation, conflict resolution and oral/written presentation. Requires strong working knowledge of utilization management, care management, regulatory standards and reimbursement across the continuum of care.
Managed care experience preferred; CCM (Certified Case Manager) preferred.
Additional related education and/or experience preferred.
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.