System Director of Case Management

Job Summary: 

• The System Director of Case Management is responsible for the overall development of the case management program.
• This position oversees the delivery of case management services within the Los Angeles service area, ensuring that patients receive coordinated, high-quality care that meets clinical, operational, and regulatory standards.
• This role supervises a team of case management directors, managers, and supervisors in the four hospitals.
• This position has oversight of all case management staff, development and implementation of case management policies and procedures, and coordination of care with other healthcare providers and community resources.
• The System Director is also responsible for ensuring that all case management metrics, KPI’s, initiatives, are on track and meeting goals and objectives.
• Maintains compliance with all applicable regulations.
• Actively and consistently contributes to department operations and communications, behaves in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) in patient communication.

Essential Functions: 

• Oversee and direct the operations of the hospital case management departments at Pipeline Health.
• Evaluate and develop a case management program at Pipeline utilizing a system approach
• Oversee leadership staff in the case management department, including hiring, training, performance management, and disciplinary action, ensuring optimal provision of services through sound personnel management.
• Assure alignment with case management overall strategic goals and objectives
• Ensure compliance with federal, state and local regulations pertaining to case management
• Drive LOS initiatives with hospital case management leadership, physician advisor and nursing leadership
• Lead denial management strategies with Revenue Cycle Team
• Assist the case management leaders with training and development of all case management staff including nurses new to the profession
• Continued assessment with case management leadership of staffing needs, ensuring stabilization of the hospital departments
• Development and implement case management policies and procedures, ensuring that they are aligned with best practices and applicable regulations.
• Provides comprehensive reporting to corporate and hospital executives and other stakeholders to include KPI’s, avoidable delays, LOS and other metrics as determined
• Build trust and confidence with physicians and hospital executives ensuring solid collaborative relationships.
• With the hospital case management leadership maintain case management department performance improvement and quality plans
• Maintain current competencies and updated knowledge in the specific area of practice.
• Effectively manage financial resources within the areas of responsibility, including labor management, productivity, observation management, avoidable days and overall LOS.
• Collaborate with UM physician chairs to develop and participate in scheduled UM Committees
• Build relationships with community partners
• Act as a clinical resource for the Hub when needed
• Participate in all payor JOMs
• Uses clear, concise, professional communication with coworkers, patients, all customers internal and external.
• Uses AIDET in interactions with patients and family members.
• Acts with a sense of urgency when performing tasks.
• Basic unit/department maintenance such as keeping files, drawers, cabinets free from unnecessary clutter.
• Reports on any equipment and or environmental issues for repair.
• Abides by HIPAA (Health Insurance Portability and Accountability Act) regulations.
• Speaks up to stop the line and escalates potential safety events if necessary.
• Completes and attends monthly training assigned.
• Other duties as assigned.

Behavioral Standards: 

• Demonstrate behaviors commensurate with the vision, mission, values, and behavioral standards of the organization.
• Serve as a role model for the mission, vision, and values of the organization and fulfill ot