We are so glad you are interested in joining Sutter Health!
Organization: SC - Sansum Clinic
Position Overview: Manages the overall operations of the Care Coordination department for Sutter Health entities in accordance with current federal and state regulations and guidelines. Has frequent contact with the Administrative Team, Nurse Executives and Directors, Risk Management & Ethics staff, Ancillary Services, Revenue Cycle and Finance Department leaders, Medical Directors, Medical Staff leaders, physicians, contracted providers, community resources post-acute agencies, patients and their families.
Job Description: These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).
JOB ACCOUNTABILITIES:
- Effectively manages the activities of the care coordination team, providing leadership and guidance.
- Determines staffing levels, interviews, and recommends for hire.
- Ensures Orientation, training and competency assessment of staff is performed and documented in a timely and effective manner.
- Evaluates staff, counsels and confronts unsatisfactory performance promptly and fairly and administers corrective action.
- Identifies department goals and objectives, develops and communicates action plans through regular staff meetings and other communications, uses team approach to problem solving and sets clear expectations.
- Identifies training needs and develops and participates in staff training. Provides a challenging, supportive environment and delegates appropriately. Seeks additional training opportunities through outside sources.
- Develops monitoring systems and measurements for the Care Coordination team and exhibits a customer service philosophy.
Designs, implements and directs Care Coordination processes for effective coordination of health care services to achieve program goals and objectives:
- Assures all services are in compliance with accrediting, statutory, regulatory and entity-specific standards by implementing and following applicable policies and procedures.
- Effectively communicates Utilization Management Program and action plan goals and objectives to the Care Coordination team. Plans activities and strategy to support effective implementation.
- Drives vision and direction through effective communication, sharing information, trending data and communicating outcome measurements for the organization.
- Organizes and presents the Care Coordination care model to internal and external groups.
- In collaboration with management, develops and administers strategic action plans for achieving goals to include patient progression, throughput, access to care and transitions of care barriers.
- Assists in preparing accurate and timely operating budgets for Care Coordination operations and monitors and tracks monthly budget goal to analyze budget variances and produce budget variance reports.
Manages the operations of the Care Coordination team to ensure cost effective utilization of department resources:
- Facilitates complex clinical and financial decision making in conjunction with the Director by presenting and escalating cases to senior management requiring administrative approval or intervention.
- Works collaboratively with management staff at Sutter Health and local skilled nursing facilities (SNFs) to assure that appropriate utilization and length of service (LOS) goals are met. Facilitates efficient and effective transitions of care to post-acute level of care (LOC).
- Tracks, analyzes and presents data to leadership and interprets findings and proposes process improvements.
- Communicates utilization findings to leadership as requested, via reports, meetings and presentations.
- Works with staff in Patient Access, claims and billing departments to resolve complex claims and follows to resolution.
- Negotiates with payers and providers in securing coverage for services medically necessary and financially sound.
- Plans and implements strategies to achieve program goals and objectives. Position has authority to determine staffing levels, interview, recommend for hire, coach and evaluate staff.
Collaborates with Care Coordination leadership team to establish an integrated continuous quality improvement process to assure high quality care, customer satisfaction and financial performance:
- Develops and implements integrated measurement and evaluation systems to monitor program performance against established process and Care Coordination outcome measures. Effectively incorporates new work processes and approaches to improve efficiency and quality of services.
- Manages and monitors sensitive risk management issues. Provides consultation regarding clinical, legal, Risk, Ethics and regulatory and reimbursement issues to case managers, physicians, and external entities.
- Provides guidance to Care Coordination staff in resolving problematic situations with clients and families, physicians and external entities. Investigates and responds to client and provider complaints regarding quality of care. Assumes responsibility for more complex cases requiring administrative intervention.
Participates as hands on team member and keeps team professionally current:
- Keeps current on industry trends and new development.
- Participates in and seeks educational forums for self and staff.
- Participates in and involves staff in professional organizations.
EDUCATION:
Bachelor's: BS in Nursing or Health Administration or equivalent education/experience OR Master's: Masters of Social Work for Social Work candidates only.
TYPICAL EXPERIENCE: 8 years recent relevant experience.
SKILLS AND KNOWLEDGE:
- Knowledge of ACMA, CMSA, and NASW Standards of Practice.
- Knowledge of available health care and community resources.
- A broad knowledge base of health care delivery and case management within a managed care environment.
- Comprehensive knowledge of laws, regulations and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS, Title 22, CHA Consent Manual, CDPH and TJC.
- Verbal and written communication skills.
- Group presentation design and facilitation skills.
- Demonstrated ability to develop and manage complex projects.
- Working knowledge of InterQual criteria.
- Working knowledge of MIDAS and experience with an E.H.R. (EPIC preferred).
- Ability to promote teamwork and to effectively function in teams, both as a leader and as a team member.
- Ability to interact effectively with key internal and external constituents using collaboration, negotiation and analytical problem resolution skills.
- Effective human relations and interpersonal skills necessary to lead the efforts of diverse health professionals to meet program objectives.
- Ability to work effectively in a fast paced environment, directing services at multiple locations.
- Analytical and mathematical skills.
- Demonstrated ability to implement continuous quality improvement processes and techniques, including benchmarking and outcomes measurements.
- PC skills, word processing, spreadsheets and managed care software programs.
- Adheres to Sutter health policies and procedures and supports Sutter health philosophies and initiatives. Participates as member of the utilization Management committee (UMC).
PHYSICAL ACTIVITIES AND REQUIREMENTS: See required physical demands, mental components, visual activities & working conditions at the following link: Job Requirements
Job Shift: Days
Schedule: Full Time
Shift Hours: 8
Days of the Week: Monday - Friday
Weekend Requirements: As Needed
Benefits: Yes
Unions: No
Position Status: Exempt
Weekly Hours: 40
Employee Status: Regular
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $53.59 to $80.39 / hour.
The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.
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