Director Care Management - Full Time - Day Shift - Pittsburgh

Highmark Health; Pittsburgh (Allegheny County); On-site; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare organization is seeking a strategic leader for the Care Management Department. The role involves operational leadership, collaboration with clinical teams, and ensuring effective patient care transitions. The ideal candidate will have extensive experience in complex transition management and strong leadership skills.

Qualifications

• At least 5 years in Complex Transition Management.
• Minimum 1 year in management or leadership roles.

Responsibilities

• Evaluate effectiveness and lead improvement efforts.
• Oversee referral management activities using Epic and Careport.
• Develop workflows for efficient care coordination.

Skills

Communication

Collaboration

Problem-solving

Resilience

Agility

Education

Bachelor's Degree in Nursing

Master's Degree in Social Work

Master's Degree in Nursing

Master's Degree in Health Administration

Master's Degree in Leadership

Tools

Microsoft Office Suite

Job description

Company :

Allegheny Health Network

Job Description :

GENERAL OVERVIEW:

Provides operational and strategic leadership for the Hospital/facility Care Management Department. Collaborates with nursing and clinical leaders to ensure smooth patient care progression, effective outcomes, and care transitions. Leads efforts with physicians, revenue cycle, payor teams, patients, and families to incorporate evidence-based practices and resource optimization. Communicates effectively with hospital leadership to develop daily and strategic goals.

ESSENTIAL RESPONSIBILITIES:

1. Evaluate effectiveness, lead improvement efforts, and assess outcomes to ensure appropriate access, care progression, transition, and care level determinations. (20%)
2. Study and implement the care management model to achieve sustainable length of stay, resource utilization, and clinical outcomes. Design and execute ongoing improvement strategies. (20%)
3. Oversee referral management activities, utilizing Epic and Careport/Allscripts data to assess effectiveness. Collaborate with Highmark Home and Community Services to strengthen post-acute networks. (15%)
4. Analyze clinical service areas for operational efficiency using dashboards and data sources. Monitor departmental performance against system goals. (10%)
5. Ensure departmental collaboration with patients, families, peers, and other departments to meet patient experience goals. (10%)
6. Promote sharing of best practices through publications, conference presentations, and networking with AHN leaders. (10%)
7. Create a development plan focusing on resource use, inter-professional collaboration, and coordination with chronic disease, transitional planning, and specialty teams. (5%)
8. Develop workflows to ensure efficient care coordination, hospital throughput, and payer compliance, minimizing financial risk. (5%)
9. Support evidence-based projects and research by identifying opportunities for scientific integration into practice. (5%)
10. Perform other duties as assigned.

QUALIFICATIONS:

Minimum

• Bachelor's Degree in Nursing OR Master's Degree in Social Work
• At least 5 years in Complex Transition Management
• Minimum 1 year in management or leadership roles
• Licensed Registered Nurse or Licensed Social Worker
• Strong communication and collaboration skills
• Problem-solving ability
• Resilience and agility as a change agent
• Proficiency in Microsoft Office Suite
• Act 34 Criminal Background Clearance
• Act 33 Child Abuse Clearance
• Act 73 FBI Fingerprinting Criminal Background Clearance

Preferred

• Master's Degree in Nursing, Health Administration, Leadership, or related field

Disclaimer: This job description outlines the general nature and essential duties of the role. It may not include all responsibilities and qualifications required.

Compliance Requirement: The role adheres to ethical, legal standards, and behavioral expectations as per company policies.

Employees may access confidential information and must comply with HIPAA, privacy policies, and data security guidelines. All staff are responsible for adhering to the company's Code of Business Conduct and applicable laws.

Highmark Health and affiliates prohibit discrimination based on protected categories and aim for accessibility. For assistance or accommodations, contact HR Services at [e-mail].