St. Anthony Hospital is located in the western Denver suburb of Lakewood and is a Level I Trauma Center with four dedicated trauma rooms including the T-10 room, a dedicated field-to-surgery suite ready 24/7 for trauma surgeons and specially trained teams who provide life-saving care to the most severely ill and injured patients. St. Anthony proudly provides a full range of medical specialties and health care services to Denver and the surrounding region with a state-of-the-art medical campus. If you're looking to be part of a fast-paced environment where you can practice to the top of your profession in trauma, cardiology, stroke, neurosciences, breast imaging, cancer/oncology care, surgery and more, we encourage you to apply. In addition to a new campus, supportive team and faith-based mission, we're proud to be the recipient of numerous awards, certifications and accreditations from the American Heart Association; Chest Pain Center (CPC); American College of Cardiology; The Joint Commission's National Quality Approval; Healthgrades (for Stroke, Critical Care and Prostate Surgery Excellence); the Emergency Nurses Association Lantern Award; NAPBC Accreditation; American College of Radiology and many others. For more information about St. Anthony Hospital, visit http://www.stanthonyhosp.org/.
Job Description/Job Posting ID: 104042
Clinic/Department: 8675 SAH CASE MANAGEMENT
Hospital: ST ANTHONY MEDICAL CAMPUS
Provides oversight, direction and leadership of the Care Coordination/Care Integration functions for the Multi Hospital Operating Group. In coordination with the Group Chief Nursing Officer and hospital CNOs, as well as facility service line leadership, supervises and coordinates the delivery of all Care Coordination services including utilization review, discharge planning and care coordination. Role includes staff education, hiring, coaching, performance management and mentoring, and financial management of the Care Coordination programs and functions. Serves as a resource for care coordination services to ensure alignment with quality and financial parameters within the entity and the group. Acts as a community liaison with external review agencies, home care providers, durable medical equipment providers, medical staff and other community resources used for discharge planning. Develops and supports relationships with joint venture facilities, services and other resources across the system. Has accountability for achieving Key Performance Indicators for Care Coordination and provides feedback, direction and leadership to key facility, group, and physician leaders, as well as the Care Coordination team. Works closely with the Physician Advisor for MNDOG to achieve improvement in reduction of one-day and two-day stays and improves management of complex cases to decrease avoidable days in hospitals. Is responsible for performance metrics monitoring and improvement.
Minimum Education Requirements
Bachelors in Nursing (BSN), required
Master's Degree required
Minimum Experience Requirements
5-7 years clinical/nursing experience in utilization review, case management and disease management.
3 years of leadership experience with focus on utilization management, case management and or care coordination with care transitions and disease management experience. (i.e. utilization/quality/care/case management) Experience in working with CMS and RAC Denials
Knowledge of regulatory compliance.
Current RN license in the state you are working in
Certification by relevant professional organizations such as CMSA, ABQAURP, ANCC or CCM, required
Position Duties (Essential Functions)
Provides leadership for facility level operations and management of multiple hospitals through effective functional leadership. He/she is a professional healthcare team member who has demonstrated skills leading healthcare initiatives. As a working role this will require the director's ability to understand and use a variety of technical software and an in-depth understanding of the EMR, MCG and Accretive systems. Understand the professional role and assure competencies in utilization and case management, and ensuring staff has the expertise to work with patients and families to move them seamlessly and transparently across our healthcare system and systems of care. Provides staff and facility managers/ supervisors with training and understanding of care coordination, case management, continuity of care practices and denial and appeal processes. Works with the facility leadership to assure available services are offered to patients including but not limited to continuity of care planning, discharge and transitional care planning resource assistance and advocacy, financial/legal resource information and assistance.
CARE COORDINATION MANAGEMENT:
Responsible for assuring appropriate review and assessment of all patients presenting for services, meet the appropriate medical necessity and appropriate service level/bed status. Must have continued knowledge and understanding of Patient Safety Standards and Quality Standards as applicable to the position as well as in CMS and state rules, regulations and guidelines.
COMMUNICATION AND TRAINING:
Will support and interact closely with the CC team to facilitate a positive and professional team environment. Will communicate with and co- chair regional/local UM/UR and complex care committee meetings. He/she will utilize information systems to monitor and report on CC functions and efficiencies and will utilize data and data analysis to trend reduction of readmissions, two--day stays, avoidable days and complex care management of specific patient cases. Will assure geographical and interdisciplinary rounding process to achieve appropriate plans of actions to assure discharge goals are met and that the patient is in the appropriate level of care for the appropriate time frame. . Works in collaboration with the Group CNO to assure system, statewide and local initiatives are developed, implemented and sustained. Develops strong relations with Nursing Council, operating group leadership, hospital senior management, physicians and key medical staff and nursing to facilitate quality and efficacious care. Excellent communication and interpersonal skills; must be able to identify and negotiate boundaries of accountability and authority with multiple disciplines. Must be able to juggle multiple projects with competing priorities.
Important notification to applicants as of Nov. 20, 2014: Effective Jan. 1, 2015, Centura Health will no longer hire tobacco users in Colorado and Kansas. The change to our policy does not apply to associates hired on or before Dec. 31, 2014. Centura Health is an Equal Opportunity Employer, M/F/D/V.