Senior Director, Care Mgmt

We are so glad you are interested in joining Sutter Health!

Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

Play a critical role in Sutter Health's pursuit to transform healthcare by achieving the highest levels of quality, access, and affordability. Partner with leadership to achieve strategic initiatives such as Total Care Accountability, developing new product offerings and building partnerships related to healthcare reform opportunities. Oversee the planning and execution of care management activities to improve the coordination and transition of care. Develop systems and day-to-day operations to manage care across Sutter Health's continuum of healthcare services—acute, ambulatory, and palliative. Collaborate with to explore optimization opportunities, to identify business efficiencies and linkages, and to encourage cross-organization communication that enhances our competitive advantage and fosters a "One Sutter" face to our patients and their families. Lead and promote system-wide and OU-based best practices related to care management resources, continuity of care, disease management, and clinical outcomes of all case management and social services in both inpatient and outpatient settings. Deliver measurable results that reveal a higher level of quality care through expanded services and performance efficiencies while offering a cost-effective and value-add healthcare environment to our patients, caregivers and customers. Where this job exists at a large affiliate, as defined as: Bay Foundation, Valley Foundation and Operating Unit (OU) roles, and reports to an Executive-Path leader, the title will be Executive.

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:

Develop and implement a comprehensive care management program that is consistent with Sutter Health's strategic initiatives while addressing current and future care continuum elements for acute,
ambulatory and palliative settings.
• Participate in developing, maintaining, updating and achieving approved short and long range care management plans for the operation unit
• Solicit, evaluate and incorporate input from top leadership, patient feedback, targeted audience populations, key learnings, and regulatory changes to formulate a foundation for an effective care
coordination strategy.
• Ensure adherence to system-level practices, policies and procedures in the development of comprehensive and cost-effective care management solutions that are consistent with Sutter Health’s strategic objectives and that deliver a high level of quality care with exceptional service.
• Evaluate disease management programs and offer recommendations to leadership regarding internal program development or purchase (in coordination with system-wide operations). Achieve operating unit care management objectives through effective operations administration.
• Deliver smooth functioning, efficient operations through timely and effective problem resolution; promptly addressing potential issues, determining root cause and offering effective solutions that can be
replicated across the enterprise.
• Establish and monitor appropriate financial management control mechanisms for all assigned hospital and non-hospital based operations; meeting or exceeding budgetary goals with regard to revenue and
expenses.
• Identify, develop and modify methods and techniques to leverage technology improvements that afford economies of scale while increasing effectiveness and efficiency.
• Develop, implement and revise techniques and practices to deliver the highest quality of care while working in a patient-focused manner.
• Monitor quality and scope of medical and nursing care for effectiveness, evaluate deviations and pursue necessary improvements including notifying appropriate leadership.
• Ensure the proper and timely reimbursement from government and third party payers to the. appropriate care management entity. Plan, design, monitor and analyze the case management program for entities within the operating unit.
• Implement case management programs that crosses the operating unit continuum of care and aligns with corporate guidelines and policies
• Ensure case management operations (where applicable) comply with National Committee for Quality Assurance (NCQA) utilization management standards
• Establish preemptive and proactive model to prepare an entities for successful recovery audit contractor (RAC) responses, including unscheduled audit drills to identif