Director Care Management - Full Time - Day Shift - Pittsburgh

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

Job summary

A leading healthcare organization in Pittsburgh is seeking a strategic leader for their Care Management Department. This role involves operational oversight, collaboration with clinical teams, and ensuring effective patient care transitions. The ideal candidate will have a strong nursing or social work background, leadership experience, and excellent communication skills. Join a committed team focused on improving patient outcomes and operational efficiency.

Qualifications

• 5 years in Complex Transition Management.
• 1 year in management or leadership role.

Responsibilities

• Evaluates effectiveness and leads improvement efforts within the hospital.
• Oversees referral management activities and collaborates with services.
• Develops workflows for efficient care coordination and compliance.

Skills

Communication

Collaboration

Problem-solving

Adaptability

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

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. Oversees efforts with physicians, revenue cycle and payor teams, and patients and families to incorporate evidence-based practices and appropriate resource use. Communicates effectively with hospital leadership on daily and strategic goals.

ESSENTIAL RESPONSIBILITIES:

1. Evaluates effectiveness, leads improvement efforts, and assesses outcomes within the hospital to ensure appropriate access, care progression, transitions, and level of care determinations. (20%)
2. Studies and implements the care management model to achieve sustainable length of stay, resource utilization, and clinical outcomes. Responsible for designing and executing ongoing improvement strategies for the care model. (20%)
3. Oversees referral management activities, utilizing Epic and Careport/Allscripts data to assess effectiveness. Collaborates with Highmark Home and Community Services to establish or enhance the post-acute network. (15%)
4. Analyzes clinical service areas for operational effectiveness using dashboards and data sources. Monitors departmental performance against system goals. (10%)
5. Ensures departmental collaboration with patients, families, peers, and other departments to meet patient experience goals. (10%)
6. Shares best practices through publications, conference presentations, and networking across AHN. (10%)
7. Establishes a departmental development plan focusing on resource use, inter-professional collaboration, and coordination with chronic disease, transitional planning, and specialty teams. (5%)
8. Develops workflows to ensure efficient care coordination, hospital throughput, and payer compliance to minimize financial risk. (5%)
9. Supports evidence-based projects and research by incorporating scientific methods into practice. (5%)
10. Performs other duties as assigned.

QUALIFICATIONS:

Minimum

• Bachelor's Degree in Nursing OR Master's Degree in Social Work
• 5 years in Complex Transition Management
• 1 year in management or leadership role
• Licensed Registered Nurse OR Licensed Social Worker
• Strong communication and collaboration skills
• Problem-solving abilities
• Resilient and adaptable change agent
• Proficiency in Microsoft Office
• Act 34 Criminal Background Clearance
• Act 33 Child Abuse Clearance
• Act 73 FBI Fingerprinting Clearance

Preferred

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

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

Compliance: The role complies with ethical and legal standards, including HIPAA and company policies. Employees must protect confidential information and adhere to all applicable laws and policies.

Highmark Health and affiliates prohibit discrimination based on protected statuses and are committed to accessibility and accommodation. For assistance or accommodations, contact HR Services at [e-mail].