Organization:

CPMC-California Pacific Med Center

Position Overview:

Supervises the overall operations of the Care Coordination department for Sutter Health entities in accordance with current Federal and State regulations and guidelines. Has frequent contact with Nurse Managers/ Directors, Risk and Ethics staff, Ancillary Services, Patient Access staff, Medical Staff leaders, physicians, Health Plans and contracted providers, community resources and post-acute agencies as well as patients and their families.

Job Description :

These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).

JOB ACCOUNTABILITIES:

Effectively manages the activities of the Care Coordination team to provide leadership and guidance.

• Position has authority to recommend staffing plans, interview, recommend for hire, coach and evaluate staff.

• Works with Manager/Director to identify department goals and objectives, develops and communicates action plans through regular staff meetings and other communications, uses team approach to problem solving and sets clear expectations.

• Works directly with staff to effectively move patients through the continuum of care through the hospital course and into post-acute settings, including monitoring, coaching, intervening, creative problem solving, removing barriers, and holding staff and self-accountable to proactive practice to manage the length of stay/throughput and ensure safe, appropriate comprehensive discharge plans are enacted.

• Collaborates with multiple providers in the care continuum to ensure optimal transitions of care, including but not limited to Skilled Nursing Facilities, Long Term Acute Care Hospital (LTACHs), shelters, Home Health Agencies, Care Transitions Teams, Federally Qualified Health Centers (FQHCs), etc. in efforts to reduce readmissions and improve patient outcomes.

• Works directly with staff to obtain and maintain proficiency in the Sutter Care Coordination Standard Utilization Management process, including teaching, coaching monitoring outcomes, and administering corrective actions.

• In collaboration with Care Coordination Educator (or equivalent), identifies training needs and develops and participates in staff training as well as orientation and onboarding of new hires and their preceptors. Provides supportive environment and delegates appropriately.

• Seeks additional training opportunities through outside sources.

• In times of staff shortage, will take direct clinical assignment.

Contributes to the design, implementation and direction of care coordination processes for effective coordination of health care services to achieve program goals and objectives.

• Coordinates with other Care Coordination and entity Managers/Directors to ensure that Care Coordination services (including Social Work Services) are in compliance with accrediting, statutory, regulatory and entity-specific standards by implementing applicable policies and procedures.

• Effectively communicates Utilization Management Program and action plan goals and objectives to the Care Coordination team and leads activities and work to support effective implementation.

• Drives vision and direction through effective communication, sharing information, trending data and communicating outcome measurements for the organization.

• Provides input to the strategic plan and vision for the department.

• Presents the Care Coordination care model to internal and external groups as needed.

Manages the operations of the Care Coordination team to ensure cost effective utilization of department resources.

• Facilitates escalation of complex clinical and financial decision making in conjunction with the Manager/ Director by presenting cases to senior management requiring administrative approval or intervention.

• Facilitates intervention with psychosocially complex patients and/or complex family dynamics by coaching Social Workers and other hospital staff and physicians to effectively intervene in the best interest of the patient.

• Communicates In collaboration with Manager/Director negotiates with payers and providers in securing coverage for services medically necessary and financially sound.

Collaborates with Care Coordination leadership team to establish an integrated continuous quality improvement process to assure high quality care, customer satisfaction and financial performance.

• In collaboration with Care Coordination leadership team, develops and implements integrated measurement and evaluation systems to monitor program performance against established process and care coordination outcome measures. Effectively incorporates new and revised work processes and approaches to improve efficiency and quality of services.

• Manages and monitors sensitive risk management issues. Provides consultation regarding clinical, legal, risk, ethics and regulatory and reimbursement issues to Care Coordination team.

• Provides guidance to Care Coordination team in resolving problematic situations with clients and families, physicians and external entities. Investigates and responds to client and provider complaints regarding quality of care. Assumes responsibility for more complex cases requiring administrative intervention.

Participates as hands on team member, maintains personal growth and development while keeping team abreast of profession:

• Keeps current on industry trends and new developments.

• Participates in and seeks educational forums for self and staff.

• Participates in and involves staff in professional organizations.

EDUCATION:

Bachelor's: BS in Nursing or evidence of enrollment in BSN program with completion within 24 months

OR Master's: Master of Social Work for Social Work Candidates Only

OR Master's: MS in Nursing, Case management

CERTIFICATION & LICENSURE:

RN-Registered Nurse of California

TYPICAL EXPERIENCE:

5 years of recent relevant experience.

SKILLS AND KNOWLEDGE:

Knowledge of ACMA, CMSA, and NASW Standards of Practice.

Knowledge of available health care and community resources

A broad knowledge base of health care delivery and case management within a managed care environment.

Comprehensive knowledge of laws, regulations and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS, Title 22, CHA Consent Manual, CDPH and TJC.

Verbal and written communication skills.

Demonstrated ability to develop and manage complex projects.

Working knowledge of InterQual criteria.

Working knowledge of MIDAS and experience with an E.H.R.

Ability to promote teamwork and to effectively function in teams, both as a leader and as a team member.

Ability to interact effectively with key internal and external constituents using collaboration, negotiation and analytical problem resolution skills.

Effective human relations and interpersonal skills necessary to lead the efforts of diverse health professionals to meet program objectives.

Ability to work effectively in a fast-paced environment, directing services at multiple locations.

Analytical and mathematical skills.

Demonstrated ability to implement continuous quality improvement processes and techniques, including benchmarking and outcomes measurements preferred.

PC skills, word processing, spreadsheets and managed care software programs.

Adheres to Sutter Health policies and procedures and supports Sutter Health philosophies and initiatives. Participates as a member of the utilization Management Committee (UMC).

PHYSICAL ACTIVITIES AND REQUIREMENTS:

See required physical demands, mental components, visual activities & working conditions at the following link: Job Requirements (https://sutterhealth.sharepoint.com/:b:/s/JobAnalysisLibrary/ETcsrLLlDj5MlmKbw2ZsPB4BlHLH2296OimmwO58T7i_Ig?e=4cI5mO)

Job Shift:

Day/Evening

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Monday - Friday, Variable

Weekend Requirements:

Rotating Weekends

Benefits:

Yes

Unions:

No

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $93.73 to $117.16 / hour

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.