Job Abstract

The Director of Care Coordination provides operational leadership, day to day supervision and administrative oversight to the Case Management and Social Services Departments by developing, interpreting and applying policies, procedures and strategies for both the inpatient and outpatient Norris populations and clinics. Responsible for departmental management, staff development and performance management.

Essential Duties:

• Demonstrates competency in the quality of work and knowledge of the job pertinent to the functioning of a Director, Care Coordination.
• Develops, implements and evaluates the annual Care Coordination / UM plan for the hospital which takes into account internal and external factors. The Care Coordination plan is designed and implemented in accordance with considerations for clinical quality, appropriate utilization of resources, timely discharge planning and payer requirements.
• Effectively manages, organizes and supervises the Care Coordination process for the hospital. Provides oversight to the plan of care with team members, clinicians, and patient/families as needed. Assists with difficult cases, communicates appropriately if the plan of care should be advanced or revised to achieve an effective discharge within established goals and available resources. Assists department staff to resolve barriers to discharge.
• Provides management oversight for services provided by social workers including psychosocial assessment, crisis intervention and supportive services for referred patients, families and staff. In conjunction with the Social Work Supervisor, formulates and implements programs to meet the psychosocial needs of the patient and family. Collaborates with all units of the hospital, physicians, nurses and other members of the healthcare team in planning the psychosocial care of the patient.
• Develops effective structures and processes to facilitate participation by physicians, pharmacists, nurses, Social Workers and other health professionals in multi-disciplinary care planning and discharge planning. In conjunction with the Physician Advisor, leads weekly interdisciplinary team reviews.
• Achieves department clinical quality, LOS and financial / budgetary goals.
• Identifies trends in utilization management, resource management, social service provision, quality management, risk management, and coding / compliance. Identifies those amenable to intervention through physician and staff education or process engineering. Assertively plans interventions and works with key individuals to see those processes to completion.
• Plans agenda for monthly utilization management committee. Preps committee chair and ensures committee recommendations are followed through to completion.
• Develops and uses measurable standards to monitor and evaluate quality and cost-effective utilization of resources in the delivery of care. Monitors space/resource requirements and utilization of outside resources.
• Compiles reports, analyzes data, and identifies significant trends in medical utilization data, such as lengths of stay, readmissions, and clinical outcomes. Reports variances through established channels. Consults with colleagues to clarify clinical details.
• Works cooperatively with the Business Office and Dispute Management teams to ensure accurate and timely claims processing.
• Understands economic and contractual impacts and facilitates pertinent communication to the staff and outside customers. Ensures that payor expectations for authorization, clinical reviews and use of contracted agencies and/or services are met. Communicates effectively with clinical staff regarding third-party restrictions on care delivery.
• Develops effective relationships with medical staff, referring physicians and managed care organizations.
• Ensures all departmental functions and activities are in compliance with appropriate regulatory standards, including, but not limited to: JCAHO, Federal, State, policies and procedures of USCUH corporate ethical and compliance standards and other applicable professional codes.
• In concert with Hospital Policy and Human Resources. Assures adherence to hospital Human Resource policies in all interactions. Responsible for all recruitment, selection, establishment of performance standards, training and disciplinary actions if needed. .Working in concert with Human Resources – responsible for all documentation to accurately support disciplinary actions including terminations. Develops an effective team for Care Coordination duties. Supervises contract staff, on-site reviewers and vendor reps.
• Proficient in the use of computers and computer programs necessary to perform job responsibilities. Demonstrates the ability to effectively train department staff in same.
• Expectations: Supports hospital’s mission and goals. Is committed to enforcing compliance with CMS regulations regarding utilization and quality management. Motivates relevant constituencies to embrace change as required clinical improvement initiatives. Leads the interdisciplinary care team in the development of effective transitional plans of patient care. Demonstrates well developed problem-solving, communication and interpersonal skills in culturally diverse environments. Negotiates effectively to achieve desired goals. Leads efforts to gain physician support for utilization, quality and regulatory compliance efforts. Leads efforts to improve hospital relationships with MCO staff. Understands trends in quality and cost management as well as managed care and capitation. Understands QIO guidelines and appeal processes.
• Other duties as requested or assigned.
   

Required Qualifications:

• Req Bachelor's degree Degree in Nursing (BSN)

• Req 5-7 years Clinical nursing experience.
• Req 5 years Experience in case management (preferably in a Hospital setting).
• Req 3-5 years Management experience.

• Req Ability to work independently, effectively manage teams while exercising sound judgment and initiative.
• Req Demonstrated ability to lead change and effectively manage conflict.

Preferred Qualifications:

• Pref Master's degree Degree in related field

Required Licenses/Certifications:

• Req Registered Nurse - RN (CA DCA)
• Req Basic Life Support (BLS) Healthcare Provider from American Heart Association
• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

USC is an equal opportunity, affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC will consider for employment all qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring ordinance. We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at uschr@usc.edu.  Inquiries will be treated as confidential to the extent permitted by law.

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