Director Care Coordination

bannerhealth; Phoenix (AZ); On-site; USD 120,000 - 160,000; Full time

Job summary

Banner Health’s Behavioral Health Utilization Review Department seeks a Director to lead a centralized team optimizing patient care through strategic utilization review. Open to an experienced RN or Social Worker with leadership and utilization review background; offers onboarding with peer mentor and collaborative culture.

Location: Banner Estrella Medical Center in Phoenix. Exempt role, Mon-Fri with on-call rotation across facilities.

Qualifications

• RN requires a BSN; licensure in the state.
• Social Worker requires MSW and LMSW or LCSW.
• Three years acute experience with age-specific population.
• Three years progressive leadership experience.

Responsibilities

• Develop and implement care and utilization management programs.
• Provide leadership and direction for Care Coordination Services.
• Direct data analysis and reporting on utilization patterns.
• Oversee recruiting, hiring, budgeting, and staff development.
• Collaborate with external stakeholders to ensure reimbursement.

Skills

Leadership

Utilization Review

Case Management

Strategic Thinking

Education

BSN in Nursing

MSW or LMSW/LCSW

Job description

Primary City/State:

Phoenix, Arizona

Department Name:

Case Mgmt-Hosp

Work Shift:

Day

Job Category:

Clinical Care

Banner Health believes leadership matters. We look for leaders who share our vision making health care easier, so life can be better. Our leaders are at the forefront of the health care transformation, planning the future of Banner Health.

Join Banner Health's Behavioral Health Utilization Review Department (BHURD) as a Director and lead a dynamic, centralized team dedicated to optimizing patient care through strategic utilization review. This pivotal leadership role seeks an experienced RN or Social Worker with a proven track record in both leadership and utilization review, offering the perfect opportunity to shape operational excellence in behavioral health services. You'll benefit from comprehensive onboarding alongside your team, a fellow director, and a dedicated peer mentor, while leveraging your collaborative spirit, adaptability, and strong leadership skills to drive meaningful change in a supportive, forward-thinking environment where flexibility and teamwork are valued as much as clinical expertise.

Location: Banner Estrella Medical Center

Exempt Role Mon-Fri (on call schedule rotates with other facility Directors)

Preferred Qualifications:

6 years experience in case management in an acute care setting, 2 years of leadership experience CCM (Certified Case Manager).

Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package.Banner Estrella Medical Center is a 353-bed acute care hospital providing a full range of health care services to the fast growing communities of west Phoenix. Opened in 2005, this is an innovative, fully electronic facility that features electronic medical records, computerized physician order entry, digital radiography, sophisticated ICU monitoring and much more. In fact, we've been named one of the "ten most innovative hospitals in the country" by Newsweek Magazine and are recognized by U.S. News and World Report as one of Phoenix's Best Hospitals. The hospital is also designed to provide a soothing, healing atmosphere for both patients and their family members. We encourage the use of such therapies as pet therapy, aromatherapy, spiritual care and Reiki Therapy.

POSITION SUMMARY

This position is responsible for the development and implementation of care and utilization management programs and services. This position provides leadership, direction and support for Care Coordination Services in the pursuit of best practice to achieve quality outcomes, reduce costs, and shape and interpret the standards required to ensure a high degree of patient, physician and employee satisfaction. This position will also have responsibilities for multiple facility/entity-specific patient outcomes related to patient goals, contractual deliverables, effective transitions of care, internal alignment initiatives, and maintaining relationships with internal and external stakeholders.

CORE FUNCTIONS

1. Plans, directs and monitors the case and utilization management program(s). Provides advice, counsel, feedback and coordination to promote a collegiality between staff, physicians and the leadership team. Ensures that development of Care Coordination services across the continuum leads to outcomes supportive of the organization’s strategic plan.
2. Ensures that development of Care Coordination services across the continuum leads to outcomes supportive of the organization’s strategic plan. Designs and implements processes to ensure appropriate care coordination in accordance with regulatory and standards of safety. Participates as a subject-matter expert and may lead or facilitate task forces, teams, and/or councils to plan, implement and coordinate post-acute programs, services, and/or activities for the organization.
3. Provides strategic direction for multidisciplinary process improvement activities, including the establishment of performance measures to attain optimal clinical, operational, financial and satisfaction outcomes. Directs the collection, analysis and presentation of data on utilization patterns and other program outcomes.
4. Oversees personnel actions including recruiting, new hire actions, interviewing and selection of new staff, salary determinations, training, and personnel evaluations. This position also participates in the development of Care Coordination goals and objectives in accordance with company standards.
5. Establishes and oversees the financial and capital resources for Care Coordination services by monitoring operating revenue and expenses, establishing and maintaining cost control programs and developing and implementing new or revised programs and/or services. Develops and implements strategies to work with all external customers to ensure appropriate reimbursement.
6. Develops and oversees the department budget(s) in conjunction with corporate goals and objectives. This position is accountable for meeting annual budgetary goals.
7. Assesses patient satisfaction in areas of responsibility; sets a high standard for staff and leadership to improve patient satisfaction as measured by survey scores.
8. This position has facility/entity-wide responsibility for Care Coordination services. Internal customers: All levels of nursing leadership and staff and other members of the integrated health care team, for the purpose of integrating services, improving patient care, ensuring effective communication systems and facilitating decision making in clinical practice and business-related issues. External customers: Patients and families regarding patient care issues; physicians regarding patient care and program development; agency vendors and contracted services; staff from other health care agencies/providers and community/professional organizations for the purpose of exchanging patient and program information and insurance payers; and the Joint Commission, state, federal and community agencies regarding compliance with laws and regulations.

MINIMUM QUALIFICATIONS

RN: Requires a Bachelor’s of Science in Nursing or in a related field.

Requires a current Registered Nurse (R.N.) license in state worked.

Social Worker: Requires a Master’s degree in Social Work. Requires Licensed Master Social Worker (LMSW) (equivalent*) or Licensed Clinical Social Worker (LCSW). An equivalent license applies to states that do not recognize an LMSW; therefore, the employee must possess a Master’s Degree and be a Licensed Social Worker.

Must have three years acute experience with age specific patient population in the area of responsibility and minimally three years of progressive leadership experience. Must possess demonstrated flexibility in responding to the needs of multiple constituencies with a service-oriented philosophy. Must also possess demonstrated skill in problem analysis, project management, contract negotiation, conflict resolution and oral/written presentation. Requires strong working knowledge of utilization management, care management, regulatory standards and reimbursement across the continuum of care.

PREFERRED QUALIFICATIONS

Managed care experience preferred; CCM (Certified Case Manager) preferred.

Additional related education and/or experience preferred.

EEO/Disabled/Veterans

Our organization supports a drug-free work environment.

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