DIRECTOR OF CARE COORDINATION (UTILIZATION MANAGEMENT COORDINATOR - RN)
Natividad
Application
Details
Posted: 09-May-23
Location: Salinas, California
Type: Full Time
Salary: $10,635.21 - $14,525.33 Month
Sector:
Hospital, Public and Private
Internal Number: SR63064
INSPIRING HEALTHY LIVES
through community
At Natividad, our dedication to the people of Monterey County is at the heart of everything we do—from the health care services we provide to the specialized programs we promote. This commitment to our community spans more than 130 years and, more importantly, has touched countless lives. It has also earned us a Joint Commission ranking in the top percentile of hospitals nationwide. If you believe in inspiring healthy lives by focusing on community-based care, consider joining Natividad today.
DIRECTOR OF CARE COORDINATION (UTILIZATION MANAGEMENT COORDINATOR - RN)
Natividad is seeking a permanent, full-time Director of Care Coordination in the Utilization Management Department. Under general direction, the Director of Care Coordination is responsible for the administration of Acute and Ambulatory Care Management and Utilization Review at Natividad. This position directs the Utilization Review (UR) & Social Services (SS) departments; develops policies and procedures for adherence to government, accrediting agency, and third-party payer standards; provides administrative support to designated physician committees; and educates professional and medical staff on acute and ambulatory care management, utilization review and transition of care practices.
Examples of Duties:
Plans, develops, implements and manages Natividad’ s Acute and Ambulatory Care Management functions to align with population healthcare needs.
Develops hospital-wide policies and procedures ensuring compliance with The Joint Commission (TJC) and other regulatory agencies.
Manages UR & SS staff and supervises daily operational activities; project planning/development; facilities planning; budget preparation; regulatory compliance; maintenance of department policy and procedures manuals, files, records and correspondence; equipment selection and maintenance; supply ordering; and vendor contract negotiations.
Provides responsible UR & SS resource/fiscal management to ensure continuous productivity, process improvement, improved customer satisfaction and achievement of department goals, objectives, and financial improvement.
Serves both as a member and administrative staff to the Utilization Review Committee, Patient Care Team and Patient Safety Quality Council.
Acts as liaison for Natividad between third-party payers, California Department of Health Care Services (DHCS), TJC, County Health Department and other regulatory and community agencies in promoting collaborative working relationships and assisting with improvement of patient flow and quality of patient care and services.
Reviews and analyzes standards and requirements established by regulatory agencies and third-party payers which govern inpatient admissions, treatments, continued stays, discharges and transitions of care.
Identifies, assesses and creates an action plan to resolve interdepartmental matters affecting care management.
Educates, trains and serves Natividad staff as subject matter expert resource on current acute and ambulatory care management, utilization review, discharge planning, transition of care and complex care-management methodologies, requirements and criteria.
Works collaboratively with Natividad Human Resources regarding recruitment, retention, development, training and performance management.
Minimum Qualifications:
Education:Completion of an accredited nursing program with a valid California Registered Nurse License.
Experience: Three years of experience as a Care Coordinator for Case Management Nurses in acute and ambulatory settings, with at least one year performing at a supervisory or management level OR five years of experience as a Registered Nurse in an acute-care hospital setting on a Medical/Surgical unit, with at least two years performing in a charge nurse capacity.
The successful candidate will have thorough knowledge of:
Population health management, program development and implementation in both acute and ambulatory settings.
Medi-Cal regulations addressing prior authorization, concurrent review and reimbursement.
TJC, Department of Health AND Human Services’ Centers for Medicare and Medicaid Services (CMS), DHCS, and regulatory standards and requirements pertaining to patient care, acute and ambulatory care management, utilization review, discharge planning and reporting requirements.
Hospital Ambulatory Services Routines.
Common disease stages, sequences, progression, processes found and resulting treatment plans frequently followed in acute, ambulatory and extended-care settings.
Principles, practices and theories of case management, utilization review and discharge planning.
Private payor reimbursement practices and procedures.
Natividad fosters a culture of service excellence and seeks candidates who have demonstrated the ability to provide and continually improve the responsiveness of that service. The Human Resource department takes a leadership role in implementing Natividad's customer service program. Customer service relations at Natividad recognizes, respects, and understands the rich diversity of the health care environment.
