CommonSpirit Health Division Director - Care Coordination - Southern California Division in Glendale, California
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health in 2019. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring, and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities advocating for poor and vulnerable people, and innovating how and where healing can happen both inside our hospitals and out in the community.
Job Summary / Purpose
The Division Director, Care Coordination is responsible for providing leadership in the development, implementation, and oversight of a care coordination model which will support a patient-centered care delivery model across the assigned division. This position is responsible for the development and implementation of standards, systems, policies, and procedures in alignment with organizational strategic initiatives and that is focused on quality and financial outcomes. Specifically, this position leads division wide efforts to optimize care coordination across the care continuum. This coordination ensures a plan of care for patients in all stages of health needs. The plan of care process will also ensure efficient resource utilization, quality outcomes, and maximize reimbursement.
** This position will support the Southern California.
Essential Key Job Responsibilities
Oversees and/or directs the development, implementation and standardization of division-wide care coordination, utilization management, and social work services policies, procedures and programs in conjunction with related goals and objectives. Ensures compliance with federal and state regulations, as well as established organizational policies and procedures.
Develops strategy and processes to align with the Office of Diversity, Inclusion and Belonging
Establishes and oversees the development and implementation of programs, short and long-range goals and objectives and determines the optimal progression to obtain these goals. Reviews analyses and reports of various activities to determine department progress toward stated goals and objectives.
Provides oversight for the medical necessity reviews, denials management, and utilization management supporting all areas of the organization within the assigned division. This includes strategy development which will improve reimbursements and reduce denials as related to federal, state and commercial programs in partnership with Common Spirit Health Partners.
Ability to develop strong partnerships with clinical partners and clinical integration activities in order to optimize care coordination across the care continuum. Ensure efficient resource utilization, improve quality outcomes and enhance patient satisfaction.
Maintains effective communication and a strong leadership presence with executive partners, senior leaders, internal and external customers to coordinate and adequately address patient care needs.
Reviews, prepares, analyzes, and presents reports and recommendations to senior management regarding operations and/or other applicable areas of interest in order to provide concise and accurate information that aids in decision-making. Develops, reviews, and monitors clinical, service and financial outcomes using performance metrics.
We care about our employees well-being and offer benefits that complement work/life balance.
We offer the following benefits to support you and your family:
Flexible spending accounts
Voluntary Protection: Group Accident, Critical Illness, and Identity Theft
Free Premium Membership to Care.com with preloaded credits for children and/or dependent adults
Employee Assistance Program (EAP) for you and your family
Paid Time Off (PTO)
Tuition Assistance for career growth and development
Matching Retirement Programs
If you want to be part of a purposeful organization built on humankindness, we invite you to join our COE today!
RN, registered nurse, care coordination, case management, ccm, case manager, director, manager, um, utilization management, healthcare, acute care, denials #DDCareCoord
Required Education and Experience
Minimum of 5 years of related experience in healthcare with a minimum of 3 years in a leadership position.
Master's degree or equivalent education / experience in nursing or healthcare/business related field preferred.
Required Licensure and Certifications
- Current Registered Nurse (R.N.) license.
Required Minimum Knowledge, Skills, Abilities and Training
Extensive understanding of case management practices and knowledge of reimbursement methodologies
Effective leadership, human relations and communications skills
Ability to identify and address customer needs in a team environment
Ability to effectively engage physicians, payers, management level staff, employees, and stakeholders in order to build partnerships, achieve strategic initiatives, and attain organizational goals.
Ability to manage problems and situations where uncertainty is inherent constructing new and innovative solutions for complex and varying problems and situations while approaching issues/problems by considering the larger perspective or context
Analytical and conceptual system-thinking and the ability to manage multiple projects.
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CommonSpirit Health participates in E-verify.
Requisition ID 2020-137360
Employment Type Full Time
Department Care Coordination
Hours / Pay Period 80
Standard Hours M-F
Facility / Process Level : Name Dignity Health System Office
Equal Opportunity CommonSpirit Health™ is an Equal Opportunity/ Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law.