The MetroHealth System is an essential health system committed to providing health care to everyone in Cuyahoga County, Ohio, and improving the health of the community overall. Its 7,400 employees deliver care to everyone at its main campus, just west of downtown Cleveland, and at more than 20 other MetroHealth locations. It also provides health care at more than 40 additional sites in Cuyahoga County through community partnerships such as the School Health Program.
MetroHealth is home to Cuyahoga County's most experienced Level I Adult Trauma Center, verified since 1992 by the Committee on Trauma of the American College of Surgeons, and one of two adult and pediatric burn centers in the state of Ohio verified by the American Burn Association. MetroHealth also is home to a verified Level II Pediatric Trauma Center.
In the past year, MetroHealth provided more than 1.3 million patient visits in its hospital and health centers. MetroHealth also is an academic medical center committed to teaching and research; each of its active physicians holds a faculty appointment at Case Western Reserve University School of Medicine. MetroHealth has earned Magnet status, which places it in the top six percent of all hospitals nationwide for nursing excellence. MetroHealth's mission is, "Leading the way to a healthier you and a healthier community through service, teaching, discovery and teamwork." For more information, visit metrohealth.org.
Director of Care Coordination and Utilization MetroHealth Medical Center
Develop and oversee strategies to manage utilization and improve the healthcare of MetroHealth patient populations. In this key position, you will contribute to patient safety by supporting System-wide programs and policies and reporting safety concerns. You will provide administrative leadership to the Center for Care Coordination, which oversees utilization and care coordination functions (RN case managers and social workers) to improve health outcomes for outpatients and inpatients. This role impacts patients in risk and non-risk models, including the MetroHealth ACO, MetroHealth employee health plan, direct contracting employers.
Collaborate with medical and nursing colleagues to optimize workflows to achieve improved clinical and financial outcomes.
Review and monitor outcome metrics to enhance system and workflow efficiency and improvements.
Develop and implement department strategies that keep pace with market changes.
Foster collaborative relationships with stakeholders to improve cross-department functions and work.
Manage and oversee use of software systems that support the departmental work and product, and leverage technology to its fullest.
Evaluate changes in care coordination and management to improve effective operations, including productivity, communication, and improved clinical outcomes for patients.
Maintain knowledge of utilization review processes, including denials and concurrent reviews.
Develop reporting methods to monitor and report on utilization, productivity and outcomes from implementation in improvement strategies.
Implement and maintain organizational structure, level of understanding, and motivation necessary for care coordination and utilization to meet institutional goals.
Ensure that operating procedures and processes measure productivity sufficient to maintain a close understanding of care coordination/utilization review outputs ensuring overall efficiency and cost effectiveness.
Oversee team performance, ensuring that managers and employees operationalize the goals of the Population Health Innovation Institute in a timely and effective manner to achieve necessary quality and financial goals.
Develop plans to expand care coordination capabilities to serve broader populations: define process/system configuration changes, identify resource and training requirements, and present recommendation to senior leadership.
Facilitate communication around the Care Coordination/Utilization Review processes with Clinical Areas, Patient Access, Patient Financial Services, Finance, Communications and others.
Serve as MetroHealth's representative with professional and community organizations by meeting with industry members to promote positive public relations, maintaining professional affiliations, and enhancing professional growth and development to keep abreast of healthcare trends.
Bachelor's degree in nursing.
Valid Ohio RN license.
Recent experience in care management or utilization review.
5 years progressive management experience in a healthcare-related organization.
Experience leading new initiatives.
Knowledge of and experience with hospital-information systems, financial-analysis systems, and the legal review of contracts.
Demonstrated initiative and evidence of continuing professional development.
Strong verbal, written communication, and analytical skills.
Ability to work with all levels of management and physician leaders.
Master's degree in nursing, healthcare administration, or business administration.
10 years progressive management experience in a healthcare-related organization.
Hospital and physician practice managed care experience.
Your skills, ambition and experience can elevate the health and well-being of friends and neighbors. Join an organization that is growing in size and significance. In return for your contributions, we offer the competitive salaries and extensive benefits you would expect of an industry leader.