Dir clin & fiscal integration

Company Name:
Elliot Hospital
Shift: Monday - Friday
Hours: 40
Job Summary:
Responsible for the overall operations of Case Management functions to drive fiscal and clinical integration. Responsible for developing systems and processes for care/utilization management, and managing the department s activities related to discharge planning. Oversees the collection, analysis, and reporting of financial and quality data related to care management processes, utilization management and LOS. Accountable for achieving established performance targets through actively engaging multiple disciplines and professional staff. Appropriately manages people, relationships, and processes in order to optimize results. Engages internal and external stakeholders in care management processes, promotes interdisciplinary collaboration, fosters teamwork, and champions service excellence.
Develops Care Management strategy, goals, policies, and procedures; develops plans, programs, systems, and staffing to meet goals of the Elliot Health System.
Leverages system-wide scope to identify opportunities to create synergy, streamline processes, improve quality, and reduce costs.
Monitors utilization trends such as delay days and DRG profiles, and other key indicators as needed to identify opportunities to improve length of stay performance.
Tracks utilization trends such as transfer patterns, operational delays and other key indicators as needed to identify opportunities and processes in need of improvement.
Conducts ongoing studies of resource utilization in collaboration with other departments.
Audit claims denials to identify appropriate remediation and develop processes to endure future reduction in claims rejection.
Plans, directs, and supervises all aspects for the Health System care program.
Finds opportunities to maximize revenue and minimize financial risk.
Understands reimbursement methodology of each third party payer for hospital and physicians
Oversees denial processes and ensures compliance with plan requirements.
Acts as internal liaison for payer auditors.
Assures that utilization of services is used in the correct setting of care.
Ensures compliance with all applicable regulations and requirements
Coordinates Care Management processes related to utilization management, case management, discharge planning, resource coordination, and quality improvement.
Builds, establishes, fosters, develops, and nurtures relationships with multiple internal and external stakeholders to garner satisfactory customer results.
Responsible for overseeing education of physicians, managers, staff patients, and families related to the care management process.
Facilitates growth and development of the care management program consistent with enterprise wide philosophy and in response to the dynamic nature of the health care environment.
Builds working relationships with other health providers in the community.
Acts as a liaison to facilitate communication and collaboration between all care partners (e.g., physicians, hospitalist, community social workers, nurses, community resources, etc.)
Maintains relationships with long-term care facilities and assists in resolving issues as necessary.
Supports the needs of physicians to provide care for patients in the most clinically appropriate setting by developing and implementing care management and outcomes management practices. Works with physicians as partners to achieve desired results for the success of all parties. Leads, directs, and/or educates physicians and office staff in the clinical care management program.
Directs and oversees the management of the staff at
Ensures maintenance of staff qualifications, competencies, staffing levels, workloads and productivity, individual personal development of staff, regulatory compliance, continuing education, performance appraisal system.
Provides clinical and managerial leadership for care coordination.
Builds constructive and effective relationships with the physicians and hospital departments
Performs generally expected management responsibilities for goal setting, staffing, continuing education, budgeting, day-to-day operations and quality improvement.
Takes initiative to ensure that department function and employees transactions and activities are in full compliance with all laws, rules, standards and Compliance Program Policies.
Continually updates knowledge of laws, rules, standards and Compliance Program policies related to department function.
Communicates laws, rules, policies, standards and expectations to employees on a regular basis and provides training, as needed.
Conducts periodic audits of department function systems, processes, transactions and employee activities to verify that activities conform to laws, rules, standards and policies.
Sets example as a leader who complies fully with all laws, rules, standards and Compliance Policies including avoiding conflicts of interest or the appearance of such conflicts.
Reports, or joins employees in reporting, potential non-compliance issues, transactions and activities to the Corporate Compliance Officer.
Creates an environment in which employees are encouraged to discuss and report potential non-compliance issues, transactions and activities.
BSN required; Master s Degree in Nursing or related field preferred.
Five (5) to ten (10) years of progressive experience in Nursing leadership and Administration required. Strong clinical background, experience in care coordination, discharge planning and overall case management experience required.
Current registration in the State of NH as a Registered Nurse required.Certification in Case Management required within one (1) year of hire.
Elliot Health System is an Equal Opportunity Employer and an Affirmative Action Employer.

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