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Director of Case Management, Milwaukee, WI


Organization: Aurora St Lukes Medical Center
Category: Director
Location: Milwaukee, WI
Date Job Posted: March 18, 2020
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How You’ll Make a Difference

Accountable for operations and integration of all care coordination strategies for all IL or WI Hospitals including the Inpatient and Emergency Department (ED) CM programs for an assigned regional area. Ensures work processes are efficient, innovative and support a single system of care coordination. Care coordination is the development of integrating services to hardwire safe seamless transitions for our patients across the continuum which will improve clinical quality, create efficiencies, reduce the total cost of care and improve the patient and family experience. Interacts with all key areas that impact care coordination such as nursing, post-acute network, home health, physicians, and outpatient care managers, etc. Oversees and is acccountable for site care management leaders within their region and ensure implementation of the common vision, goal alignment, effective communication, sharing of expertise and leveraging resources at IL and WI hospitals to achieve economies of scale.

Accountable for contributing to development of the enterprise strategic and annual operating plans for IL or WI for Advocate Aurora care coordination inpatient and ED care management programs in alignment with enterprise population health. Integrates national best practices and benchmarks into the program to ensure optimal outcomes for the healthcare system. Ensures the care management inpatient program goals are aligned with the overall AdvocateAurora strategic initiatives in enterprise population health. Responsible for developing a professional, team-oriented, service culture that contributes to the goals of the enterprise and department. Has expert knowledge of the processes related to financials in the revenue cycle model; supports and directs initiatives that result in improved quality, efficiency and financial performance.

Provides regional accountability and oversight for the development of structures, processes and initiatives designed to improve care coordination projects that will define the continuum of care for each patient population and best practice solutions for care coordination. Ensures that there is a plan for education, communication, training and implementation planning. Serves as a regional leader for oversight for the AdvocateAurora site care management leaders to ensure delivery of the vision, strategies, and roadmap including utilization outcomes, process metrics, and financial performance of all value based contracts which have a significant impact on the AdvocateAurora financial performance.

Provides leadership and mentorship to the site Managers and Supervisors of Care Management for effective implementation and optimal performance. Leads in setting performance management goals, operating plans, dashboards, and outcome tracking tools to ensure performance is monitored, on target and achieving intended outcomes. Responsible for rounding on site care management leaders at AdvocateAurora sites including observations and onsite reviews and rounds to ensure project deployment and operation are in alignment with system goals and targets. Works with performance improvement and project managers as project leads related to care coordination tactics as assigned such as Medicare Bundled Payments for Care Initiatives and Medicare Shared Savings Program.

Accountable for communication and data reporting to Site Leadership Teams and key stakeholders. Provides leadership and mentorship to site managers and supervisors to ensure effective implementation, change management, and optimal performance. Collaborates with Executive Director in setting KRAs, operating plans, dashboards, and outcome tracking tools to ensure performance is monitored, on target and achieving intended outcomes.

Accountable for site operating / capital budgets for IL / WI.

Ensures that the site care management programs for the assigned region operate under compliant CMS, federal and state practice standards and codes of ethics.

Ensures appropriate care management tools and software are operational and support the needs of the strategic plan and initiatives for Integrated Care Management for AdvocateAurora Health.

Site oversight for the utilization management operations for Advocate Aurora Health as assigned that are part of the comprehensive care management program that supports reimbursement and revenue enhancement. Works collaboratively with payers, providers to ensure a standardized, efficient, and highly effective process for UM. Identifies opportunities related to appeals of medical necessity denials and quality inquires. Demonstrates expertise in utilization management and clinical reimbursement that demonstrates a working knowledge of current admission, continued stay, and discharge appropriateness criteria.

Qualifications

License & Certifications

Registered Nurse license issued by the state in which the team member practices, and Accredited Case Manager (ACM) certification issued by the American Case Management Association (ACMA) needs to be obtained within 1 year, or Care Manager Certified (CMC) certification issued by the National Academy of Certified Care Managers (NACCM) needs to be obtained within 1 year, or Nursing Case Management (RN-BC) certification issued by the American Nurses Credentialing Center (ANCC) needs to be obtained within 1 year.

Education

Master's Degree in Nursing, or Master's Degree in Health Care Administration or related field, and Bachelor's Degree in Nursing.

Experience

Typically requires 7 years of experience in a clinical environment.
Includes 3 years of management experience in a clinical environment.
Strong analytical ability to gather, interpret, and utilize data in decision-making.Demonstrated self-direction and results orientation.Expertise in operations improvement and quality management.Demonstrated excellence in organizational and project management skill.Critical thinking skills.Proficiency with word processing, spreadsheet, PowerPoint and graphic presentation software.Demonstrated political sensitivity to the dynamic interplay that occurs between hospital sites.Demonstrated success facilitating teams on complex projects.Strong leadership skills.Ability to work in an unstructured, developing environment.Frequent travel.Understanding of analytics and performance metrics that drive behavior.Experience working with contracts where financial performance is at risk for a health care delivery system.Strong operational skills including strategic planning, operational work plans with demonstrated adherence to timelines.Ability to lead a team and work with a diverse team of stakeholders.Excellent presentation skills with experience communicating with high level executives internally and externally with outside stakeholders.

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